复古之医术以吉益东洞为最，东郭出其门下，独不奉其衣钵，别成一大家。盖譬之兵
家，东
洞医如韩信行军，背水绝粮，置之死地而后生。东郭医如李靖用兵，度越纵舍，卒与法会。
各有其长，不易优劣。学人于此处着眼，庶几得二家之真矣。(拙轩曰∶古人往往以兵家之
事拟医术，先生以韩信李靖评二氏更妙。)
病瘫痪肩 骨开脱如容五指者不治。又握掌不开者不治，开而不握者治。
《证治准绳》论婴儿尤精，足以见王宇泰之苦心。转胞六味丸治验亦可玩味。
病转胞脐下有块，其形圆者治。若扁如柿核者不治。此证以八味丸为套法，而四逆散加
附子，抑肝散加芍药亦奏效，不可不审。
水气不虚不实，其肿光艳者，鲤鱼汤为得。
水气入胸膈，及肩背拘急如束缚者，为犀角的证。
一角能治水气上冲，故用之香港脚冲心颇效。
打扑有似瘀血冲心而否者，曾睹山陬一妇人大损伤，精神昏愦。腹中如杯盆者，迫于心
下颇
闷乱，脉息仅不绝耳。余作走马汤与之，服已须臾，烦躁，吐泻清水数升，霍然而愈。故知
不可慨为瘀血而治也。
油风多用大柴胡汤而效。是宜治其腹，徒不可泥其证。(华冈青洲治此证，以大柴胡加
石膏汤，曰油风多属肝火，亦同见。)
每称东洞曰∶先生治足委弱不能步行者，与桂枝加术附汤，兼服紫圆速愈，可谓妙矣。
(此
上焦得通，津液得下之旨。东郭夙入其室。)(拙轩曰∶青洲翁疗梅疮结毒，顽结难愈者，用
桂枝加术乌汤，兼用消毒丸，应手而痊。盖从此处脱胎来。)
一妇人年三十有五，背脊佝偻，身不能动摇，足屈而不伸，脉沉紧，其形如十岁许儿，
即与理气汤，兼服紫圆，六月后与慈菇汤，脚伸病方愈。
桃花汤治痢病便脓血极效。盖初起与之无益，其期在热气稍解，脓血不止。论曰∶二三
日至四五日其旨深矣。
余常用桃花汤为散，白汤送下得效。若少阴病形悉具，特便脓血者，以真武汤，服桃花
散亦可。
世所称中风多因 瘕为偏害，宜诊腹以处方，故大柴胡汤加甘草，抑肝散加芍药等，能
治此证。其他如手足痹痿痹，亦世医徒拘其证，不察其因，宜矣不得其效也。
一老人痰喘气急有 瘕，细柳安以为劳役，与补中益气汤，痰喘益剧。余诊曰∶此人性
豪强
，壮年起家，故肝郁生症，加之水饮聚结以为喘急也。乃与宽中汤加吴茱萸，病安后感寒为
下利，因与真武汤利止，以四逆散加薯蓣、生 全愈。
一男子犯寒夜步，因感冒短气，手足微冷。医以为中寒，与四逆汤，服后短气益甚，咳
嗽面赤。因与越婢加术苓汤顿愈。
病者目赤眼睛不转如鱼目者，为难治之候。
病患不论缓急，将诊之。宜隔床望见其形气，形气缩小，神彩枯瘁者，死候，不必持脉
而知之。
脱证误与攻击药，则爪甲忽失光泽，不可不知。
神阙脉亦为治诸病要诀。按之沉小不移者，形体虽虚，为实候，宜攻之。若浮芤无力者
，为虚候，如水分之动亦同之。
伤寒舌圆浓者，又薄小者，皆为恶候。又始终白胎不变者，亦为难治候。又浓者赤者，
皆为虚也。(卢不远曰∶伤寒可以神舌识病。则风暑燥湿，恐亦有定法。此言诚为隅反矣。)
脐下悸，按之与呼吸相应者，病患虽危笃，其死有间。香港脚、劳瘵、湿毒三病，当脐上
五六分任脉外各一寸许，不拘左右必有动气。香港脚则弦急，劳瘵则虚数，毒则无定形。
凡大病眼中爽者恶候，不了了者反有生意。劳瘵及杂病眼神与病相应者为佳。
诊大病鼻梁亦为要诀。医书徒论明堂而不及此，为阙典。
腹胀攻下无效者，有漫游散气。则顿愈者，此因心下素有积为胀满也。(按《灵枢》云
∶夫
胀者，皆在于脏腑之外，排脏腑而郭胸胁胀皮肤，故命曰胀。东郭所论，盖斥此等之证而言
也。)
石膏非大剂则无效，故白虎汤、竹叶石膏汤。其他石膏诸方，其量过于平剂。世医不知
此意
，为小剂用之，譬如一杯水救一车薪火，宜乎无效也。(拙轩曰∶此言甚好，伤寒诸方之石
膏，则剂可大，而服数不可多焉。至杂病，则非大剂决不能奏效，放胆用之而益可，况今医
人恐石膏殆如蛇蝎噫。)
感风寒咽喉肿塞，药汁难通者，作驱风解毒汤加桔梗、石膏冷服，极效。(拙轩曰∶此
证小柴胡加桔梗、石膏，亦奇中，青洲翁曾用之。)
伤寒大热烦渴谵语，欲饮水数升者，固为白虎汤、承气汤的证。而又有假热者，有水邪
者，故真武汤或犀角、生 类。有时为市医者，宜审脉证谛腹诊以决真假矣。
伤寒面合赤色者，升阳散火汤、犀角汤(《医学纲目》)间效。若服之二三日不愈者，多
为戴阳难治。
治疗有先后之序，紊之则无效。一病患足心至胯间烦热，日夜数十发，殆如有火往来
。医以
为香港脚，治之不差。余诊之，脐右以至少腹磊块应手，此属燥屎，因问其大便曰不通。乃作
调胃承气汤与之，燥屎悉出而后治其香港脚，诸证全愈。是其明征。
疝阴囊肿大与治疝诸方不愈者，与半夏浓朴汤加犀角速效。又经闭与逐瘀诸剂不治者，
与安中散、抑肝散等得效。是皆欲得南风，必发北牖之理。医不可不知此活手段。
小儿慢惊风及中暑者，其口为如笑者必死。
因毒瓦斯而声哑者，加喘气则多死。
吴氏所论疫京师十年前大行，其后绝无。盖疫者年年异其证，而发于柴胡者多。则募原
说不为无理。(仙台工藤周庵着救瘟袖历论，因时运异证。亦可参考。)
霉毒家口中烂、耳鸣、咽喉腐蚀、头痛、肩背痛、声哑、吐沫、齿断强直，八证者，皆
系轻粉毒，宜详之。
天庭色衰者为虚，色盛者为吉，色痿有皱纹者为难治，日月额凹陷者死，失色者为难治
，无
生气或羸脱者死，耳痿失色者死，发际有白点者死，面冷或鼻冷或少商穴冷者死，额上冷者
死，此皆望色决死生之要诀也。(按∶《医学正传》小儿门汤氏说云∶山根若见脉横者，知
两度惊。相书鼻为山根，山根有疾，尤非佳兆矣。然东晋谢安、北宋刘贡父俱有是疾，一则
德望盖世，一则博识该览。居一代诸贤之右，亦不可拘物理小识云∶小儿乳哺时母有孕，辄
眉心黑泄泻，据之则眉间亦可精察。)
胁下引背脊痛者，多属畜血，不可概为悬饮。
世所称脓淋者非淋，即《外科正宗》蚀疳也，宜解毒剂。
急喉痹秘寒不能饮下者，与苦酒汤效，或平素患咽肿者亦效。一男患咽痛，后元气衰乏
，下利咽肿而燥，难言语者，与苦酒汤，初痛楚不能咽，后快通愈。
病患绝脉者，暴出为恶候，微续为佳兆，不止脉如厥逆亦然。
治病求本为要。譬如鼻痛、耳痛、耳聋，徒为耳鼻之治，此即舍本执末也。为医者宜认
其所以然而治之。
用方以活变为主，某方治脱肛，某药主下血，概用之者，不知活变也。一方以应万病，
万病以归一方，是谓活变也。
心胸痞塞，用芍药、甘草类不应者，半夏浓朴汤加芎 ，轻其剂量而服之则效。(拙轩
曰∶如此条所言东郭翁极得意手段，玩味有余，下条亦然。)
泄利与附子剂不止者，钱氏白术散奏效。此理可玩。
一妇人羸瘦盗汗，下利十余行，腹中拘急如摸罗网，不欲饮食时喘者，与真武汤愈。
伤寒与下剂，以其脉沉实沉紧为的也。(此语非大有见识，大明脉理者不能道，诚与仲
师用承气之旨符合。)
病患有心下痞硬，腹中拘急而遗精或漏精者，概为下元虚治之，则痞硬益甚。先治其痞
，则遗精亦随愈。
病咳血心下有水，左肋及胁下拘急动悸者，与柴胡姜桂汤加吴茱萸、茯苓愈。此治腹而
血自
治也。(拙轩曰∶翁之用四逆散、柴胡姜桂汤、八味丸等，纵横颠倒，变化无方，实极得心
应手之妙，他人不可及也。然精思求之，岂不得其仿佛乎。)
诸疮内攻，及香港脚上冲，与木瓜、吴茱萸、犀角等无效者，四物加黄柏、山栀子，或四
物加浮萍能治之。盖不制水湿而治血虚，最是上乘法。
生地黄能治心下痞硬，干地黄亦然，但其效不如生耳。
京师一时咳嗽大行，有人患之，诸药无验。荻野台州以为下元虚，与八味丸不应。诊之
左肋拘急，因与四逆散加吴茱萸、牡蛎速愈。
一妇人数日自汗不食，脚挛急，脐下有块而痛，其状颇似蓐劳，众医治之不愈。余以块
为主证，与安中散，块渐消，汗随止，全愈。
久腹痛者，徒禁浓粱而不减饮食，则虽方证相对，更无效。
腹痛发呕吐者，不详其因而治之，则误人不浅鲜，因者何？曰积聚，曰停食，曰蛔虫，
曰水饮
，曰瘀血，曰肠痈是也。积聚心下痞硬，按之则反胀。停食心下濡，按之如空，蛔虫按之指
下有气筑筑然。瘀血多在脐旁及少腹，按其痛处块应手。水饮其痛游走不定，按之则鸣动。
肠痈多右腹，按之左右异状。且手足痛处则必觉润泽，右足挛急，小便淋沥。余多年潜心辨
此六者，无有差忒。
风眼痛剧者，与紫圆六七分大下之即效。(拙轩曰∶专门眼科曾有此快活手段耶。)
霉毒热甚者，以清解为主。若解发不彻，则多为沉痼废疾。此法医书未说及，为可深惜
矣。
偏枯证有治不治之辨，病者握手者决不治。试使握手仰卧，则其手必开，复起之则如故
，是为恶候。
禁口痢者，胃口至胃中多畜水饮，故水分动气甚。附子理中汤加粳米，或加薯蓣、生
效，又将生鸡肝入酱煮熟取汁服之。
掘河丸太街一富商女年十八，患麻疹，其状细小，欲发不能发，隐隐于皮肉，大热如火
，呕
逆，水药不能纳口。余以为热毒内攻所致，乃与调胃承气汤，病阻不能服。因延田中信藏诊
之曰∶余有浴法试之，家人疑议。余曰∶药不能下，施之而可。信藏乃以清酒和热汤盛之于
盘内，使病者沐浴其中，须臾出之，温覆取汗，则呕吐忽止，疹悉发。(拙轩曰∶魏氏博爱
心鉴水杨汤浴痘儿之法，与此条同巧异曲。)治痘法以辨胃强弱为要，虽有下利、烦渴、
寒战、切牙等证，胃气强者可治。补泻之分，全在此一途。
老人顽癣，多因血液干燥，湿热熏肌表。故温清饮为的治，或加浮萍佳。
香港脚动气甚者，四物汤或效，盖以水分动为标准也。
哕逆属胸中者，主橘皮、竹茹、丁香。其属腹中者，主附子粳米汤，合甘草干姜汤。若
有水饮中气虚者，主香砂六君子加芍药也。
产前后口舌赤烂 痛者，实者以麦门加石膏汤，三黄加石膏汤为主。在虚实间者，以加
味逍
遥散为主。极虚者，以附子汤加当归为主。若赤烂生白点者，为恶候。加下利者，为不治。
诸病其脉时时变易者，属痫也。
余曾谓芍药缓肝，当归润肝，川芎疏肝，生地黄泻肝。其能各异，而要之不能出肝分。
卒厥人趺阳脉应手者，为恶候，何者？胃气脱则趺阳反鼓动。宜审其神气有无，吐与利
证异而因同，医当晓其理。
诸病凝结心下者，多属肝气。疫证亦多挟肝气，宜察焉。
赤游丹毒不早下之，则内攻为走马牙疳，宜凉膈散加犀角。
霉毒上攻，头上肿起为凸凹者，属火证。宜温清饮，霉毒动生火，不可徒为湿而治焉。
久病患左右偏卧者，一朝忽得自由卧，则死期在近。
池田瑞仙(锦桥)诊痘甚粗，如不用意者，或人问之。曰∶诊察过密，则反失真。其妙存
于目
击之间，譬如睹刑人之就死地，虽刚强者其气馁，憔悴之状，在过眼之间，若熟视久之，则
其形气与常人无异矣。余治妙法大王臣菅谷中务卿男，啖柿果伤胃，发大吐泻，四肢厥冷过
肘膝，换数百方治之无效，束手俟死。余望之形容自有生气，因与理中安蛔汤，忽苏息矣。
是前医则熟视刑人也，余则一见于道途也，可谓瑞仙真得实诣者矣。
患 囊者，足痿就蓐，则多不治。
结毒入眼瞳人陷缺者，为用汞剂之的，非他药之所治也。消息与汞剂，则瞳人圆满复故
。若不圆满反紧小，神水流散者，不治。
因结毒成聋者，成青盲者，成声哑者，皆不治。但聋耳有所少闻者，远房服药，则愈。
服轻粉口中腐烂者，石榴皮、松脂等分煎服效。
凡与粉剂者，先与泻火药，而后与之为佳。此与疗打扑者先行拆水，而后服，酒奏全效
，同一理。
会阴打扑小便不通，但少尿血者，与桃核承气汤。若不瘥者，与大黄附子汤一帖，用附
子二
钱为佳，服之小便快利血止为度。又因证可与八味丸，是真藤元志试效方云。(拙轩曰∶会
阴打扑其证剧，并尿血涓滴不通苦闷者，内用甘遂、大戟峻剂，外施导水管，不然无救法。
此条所言，盖属缓证。)
癖逼塞胸膈者，脉异左右，癖之所在，其脉必涩，癖之所无，其脉必数也。又有其人
常脉迟，因癖而为动数者。
癖人横卧有下癖而眠者，有上癖而眠者。审之其下癖者，必因胸中冲逆甚也。
舌色纯红而柔软，其形失常干燥者，为参附所宜与之。舌色不变者，恶候也。若无汗谵
语烦
The medical practice of restoring antiquity is best represented by Yoshikawa Tōdō. Wada Tōka, coming from his school, alone did not inherit his mantle but established a distinct major school. It is like military strategy: Tōdō's medicine is like Han Xin marching an army, fighting with his back to the river and cutting off rations, placing soldiers in a desperate situation to ensure survival. Tōka's medicine is like Li Jing using troops, flexible in deployment and retreat, ultimately conforming to military laws. Both have their strengths, making it difficult to judge superiority or inferiority. Scholars who focus on this aspect may well grasp the essence of both schools. (Zhuoxuan said: Ancients often compared medicine to military affairs; Mr. comparing these two physicians to Han Xin and Li Jing is even more ingenious.)
Paralysis with shoulder joint dislocation allowing space for five fingers is incurable. Also, a clenched fist that cannot be opened is incurable, while an open hand that cannot grip is treatable.
*Zhengzhi Zhunshen* discusses infant diseases with great precision, revealing Wang Yutai's painstaking effort. The verified case of treating *Zhuanbao* (bladder qi transformation dysfunction leading to urinary retention) with Liuwei Wan is also worth pondering.
For *Zhuanbao* with a lump under the navel, if round in shape, it is treatable. If flat like a persimmon seed, it is incurable. This condition typically uses Bawei Wan as standard treatment, but Sini San plus Fuzi, or Yigan San plus Shaoyao, can also be effective; careful examination is essential.
For Shuiqi (water qi) disease that is neither deficiency nor excess, with swelling that is bright and lustrous, Likang Tang is most appropriate.
When Shuiqi invades the chest and diaphragm, causing stiffness and binding sensations in the shoulders and back, it is an indication for Xijiao (Rhinoceros Horn).
Xijiao can treat upward rushing of water qi, thus being quite effective for Hongxiangjiao (gout/lower limb edema) rushing to the heart.
Traumatic injuries may present similarly to blood stasis rushing to the heart but are not such cases. I once saw a woman in a mountainous area suffering severe trauma, with mental confusion. She felt a blockage in her abdomen like cups and basins, pressing on the epigastrium causing stifling and restlessness, with only a faint pulse remaining. I administered Zouma Tang. Shortly after ingestion, she became restless, vomiting and purging several liters of clear fluid, and recovered suddenly. Thus, one must not indiscriminately treat such cases as blood stasis.
Youfeng (alopecia areata) is often treated effectively with Da Chaihu Tang. Treatment should focus on abdominal symptoms rather than rigidly adhering to surface manifestations. (Hua Gang Qinzhou treated this condition with Da Chaihu Tang plus Shigao, stating that Youfeng often belongs to Liver Fire, sharing the same view.)
People often praise Master Tōdō for treating weakness in the Weizhong area of the foot preventing walking by administering Guizhi Jia Zhu Fu Tang, combined with Zijuan, resulting in rapid recovery—a skillful approach. (This embodies the principle of "upper jiao unblocked, fluids descending." Tōka had previously studied this deeply.) (Zhuoxuan said: Master Qinzhou treated stubborn syphilitic chancres using Guizhi Jia Zhu Wu Tang combined with Xiaodu Wan, achieving quick cures. This likely originated from this method.)
A thirty-five-year-old woman suffered from spinal curvature, immobility, and flexed legs unable to extend, with a deep and tight pulse, resembling a ten-year-old child. I immediately prescribed Liqi Tang combined with Zijuan. After six months, Cigu Tang was given, leading to leg extension and full recovery.
Taohua Tang is extremely effective for dysentery with pus and blood in stool. It is ineffective at the onset; its application lies when heat subsides slightly but pus and blood persist. The theory states: "From the second or third day to the fourth or fifth day," implying profound significance.
I commonly use Taohua Tang in powder form, taken with warm water for good results. If all signs of Shaoyin disease are present, specifically with pus and blood in stool, Zhenwu Tang can be used, or Taohua San concurrently.
Commonly termed stroke in the world is often caused by Jiaju (abdominal masses) causing hemiplegia. Prescription should be based on abdominal diagnosis; thus, Da Chaihu Tang plus Gancao, or Yigan San plus Shaoyao, can treat this condition. Similarly, for numbness and paralysis of limbs, worldly physicians often stick to symptoms without investigating causes, hence failing to achieve efficacy.
An elderly man with phlegm-wheezing,急促 breathing, and abdominal masses was diagnosed by Xiulian An as fatigue-induced, and given Buzhong Yiqi Tang, which worsened his wheezing. Upon examination, I stated: This person has a strong temperament, rose to prominence in youth, leading to Liver Qi stagnation forming masses, compounded by fluid retention causing wheezing. I prescribed Kuanzhong Tang plus Wuzhuyu. After stabilization, he caught a cold leading to diarrhea, treated with Zhenwu Tang to stop diarrhea, followed by Sini San plus Shanyu and Shengjiang, resulting in complete recovery.
A man contracted cold while walking at night, developing shortness of breath and slightly cold extremities due to wind-cold invasion. A physician diagnosed it as Cold Invasion and administered Sini Tang, which worsened his shortness of breath, causing coughing and facial redness. I then prescribed Yebing Jia Shu Ling Tang, resulting in immediate recovery.
Patients with red eyes and immobile pupils resembling fish eyes represent a difficult-to-treat prognosis.
Regardless of urgency, before examining a patient, observe their form and spirit from across the bed. If the form is shrunken and spirit withered, it is a death omen, known without needing to palpate the pulse.
In collapse syndromes, mistakenly using attacking drugs causes nails to lose luster suddenly; this must be known.
The Shenque pulse is also a key to treating various diseases. If depressed and small without shifting upon pressure, despite physical weakness, it indicates an excess syndrome suitable for purging. If floating and hollow with no strength, it indicates deficiency, similar to movement at the Shuifen point.
In Shanghan, a thick, rounded tongue coating or a thin, small tongue are both bad omens. Persistent white coating throughout the illness is also difficult to treat. Thick or red coatings indicate deficiency. (Lu Buyuan said: Shanghan can be identified through tongue observation. Perhaps Wind, Summerheat, Dryness, and Dampness also have fixed methods. This statement truly exemplifies drawing inferences.)
Palpitations under the navel corresponding to respiration indicate that although the patient is critical, death is delayed. For Hongxiangjiao, Laozai (consumption), and Shedú (toxic dampness), there is always moving qi approximately one cun outside the Ren meridian, five to six fen above the navel, on either side. Hongxiangjiao presents with wiry and tense pulses; Laozai with deficient and rapid pulses; Shedú with irregular forms.
Clear eyes in serious illness are a bad omen; cloudy vision often implies vitality. In Laozai and miscellaneous diseases, eye expression matching the illness is favorable.
Observing the nasal bridge is crucial in diagnosing serious illnesses. Medical texts discuss only the Mingtang (nose tip), neglecting this area, which is a omission.
Abdominal distension unresponsive to purging may resolve instantly if "roaming gas" is addressed, indicating prior accumulation in the epigastrium causing distension. (According to *Lingshu*: Distension occurs outside the organs, pushing them aside and expanding the chest and hypochondrium, hence named distension. Tōka's discussion likely refers to such conditions.)
Shigao (Gypsum Fibrosum) is ineffective unless used in large doses. Therefore, Baihu Tang, Zhuye Shigao Tang, and other formulas containing Shigao use quantities exceeding standard doses. Worldly physicians do not understand this, using small doses, akin to saving a cartload of burning firewood with a cup of water—naturally ineffective. (Zhuoxuan said: This is excellent advice. For Shanghan formulas, Shigao dosage can be large, but frequency should not be high. For miscellaneous diseases, large doses are decisive; use boldly. Alas, modern physicians fear Shigao as if it were a snake or scorpion.)
For wind-cold causing throat swelling and obstruction preventing liquid intake, Qu Feng Jie Du Tang plus Jiegeng and Shigao, taken cold, is highly effective. (Zhuoxuan said: Xiao Chaihu Tang plus Jiegeng and Shigao also works miraculously for this condition; Master Qinzhou has used it.)
In Shanghan, high fever, irritability, thirst, delirium, and desire to drink several liters of water are indications for Baihu Tang or Chengqi Tang. However, there are false heat patterns and water pathogen patterns, where Zhenwu Tang or Xijiao and Shengjiang may apply. Physicians must carefully examine pulses, symptoms, and abdomen to distinguish true from false.
Reddish face in Shanghan may respond occasionally to Shengyang Sanhuo Tang or Xijiao Tang (*Yixue Gangmu*). If unresolved after two to three days, it is likely Daiyang syndrome, which is difficult to treat.
Treatment order matters; disrupting it leads to ineffectiveness. A patient suffered intense heat between soles and groin, dozens of times daily, feeling like fire passing through. Diagnosed as Hongxiangjiao, treatment failed. Examination revealed a hard mass from right umbilicus to lower abdomen, indicating dry feces. Asking about bowel movements confirmed constipation. I gave Tiaowei Chengqi Tang. After dry feces passed, treating Hongxiangjiao resolved all symptoms. This is clear evidence.
Scrotal hernia with massive swelling unresponsive to standard treatments responds quickly to Banxia Houpo Tang plus Xijiao. Amenorrhea unresponsive to blood-invigorating agents responds to Anzhong San or Yigan San. These illustrate the principle of opening the north window to get the south wind. Physicians must know such flexible methods.
Infant slow convulsions and heatstroke with a smiling mouth shape indicate certain death.
Hoarseness due to toxic vapors accompanied by asthma indicates probable death.
Wu discussed epidemics prevalent in the capital ten years ago, which later ceased. Epidemics change yearly, often presenting as Chaihu patterns. Thus, the Mòyuán theory is not unreasonable. (Kudo Shūan of Sendai wrote *Juwenshouli Lun*, noting varying symptoms due to changing fortune/time. Refer also.)
Syphilitic patients with oral ulcers, tinnitus, throat corrosion, headache, shoulder/back pain, hoarseness, foaming, and broken/stiff teeth exhibit eight signs of Qingfen (calomel/mercury) poisoning; detailed differentiation is required.
Pale color in the Tian Ting area indicates deficiency; vibrant color is auspicious; withered color with wrinkles is difficult to treat; sunken日月额 indicates death; loss of color is difficult; lack of vitality or emaciation indicates death; withered ears with loss of color indicate death; white spots at hairline indicate death; cold face, nose, Shaoshang point, or forehead indicate death. These are key rules for determining life and death through complexion observation. (Note: *Yixue Zhengchuan* infant section by Tang Shi says: Horizontal lines at Shan Gen (root of nose) indicate past convulsions. Physiognomy calls the nose Shan Gen; disease here is ill-omened. Yet Xie An of Eastern Jin and Liu Gongfu of Northern Song had this trait; one had supreme virtue, the other vast knowledge, surpassing contemporaries. One cannot cling to trivial observations. *Wuli Xiaoshi* notes: If mother is pregnant during breastfeeding, infant may have dark eyebrows and diarrhea; thus eyebrow area can also be precisely observed.)
Pain in hypochondrium radiating to spine often belongs to Blood Stasis, not necessarily Xuan Yin (pleural effusion).
Worldly "purulent strangury" is not strangury but *Shigan* (corrosive chancre) from *Waike Zhengzong*; detoxifying agents are appropriate.
Acute sore throat with cold obstruction preventing swallowing responds to Kujiu Tang, or for chronic throat swelling. A male patient with sore throat, subsequent qi deficiency, diarrhea, swollen/dry throat, and difficulty speaking was treated with Kujiu Tang. Initially painful to swallow, later relieved and cured.
Absent pulses in patients: sudden emergence is a bad omen; gradual return is auspicious. Same applies to reversal cold limbs.
Treating disease requires addressing the root. Treating nose/ear pain/hearing loss solely locally is abandoning the root for the branch. Physicians must identify the cause.
Prescribing requires flexibility. Applying specific formulas/drugs rigidly to hemorrhoids or bleeding shows lack of flexibility. Adapting one formula to myriad diseases, or reducing myriad diseases to one formula, constitutes flexibility.
Chest/epigastric stuffiness unresponsive to Shaoyao/Gancao groups responds to Banxia Houpo Tang plus Chuanxiong at reduced dosage. (Zhuoxuan said: This reflects Master Tōka's得意 technique, worthy of study, as is the next item.)
Diarrhea unresponsive to Fuzi preparations responds to Qian Shi Baizhu San. This logic is worth pondering.
A thin woman with night sweats, frequent diarrhea (>10 times), abdominal cramping like touching a net, anorexia, and occasional wheezing was cured with Zhenwu Tang.
In Shanghan, purgatives are indicated by deep, solid, or deep, tight pulses. (This insight requires profound understanding of pulses, aligning with Zhongjing's use of Chengqi formulas.)
Patients with epigastric hardness/fullness, abdominal cramping, and seminal emission/leakage are often wrongly treated as Kidney Yang deficiency, worsening hardness. Treating the epigastric issue first resolves emission.
Coughing blood with fluid retention under the heart, left rib/hypochondrium cramping/palpitation responds to Chaihu Jiang Gui Tang plus Wuzhuyu and Fuling. Treating the abdomen stops the bleeding. (Zhuoxuan said: Master's versatile use of Sini San, Chaihu Jiang Gui Tang, Bawei Wan, etc., shows masterful adaptability unmatched by others. Deep reflection reveals how one might approximate this.)
Internalized sores and Hongxiangjiao rushing upward unresponsive to Mugua, Wuzhuyu, Xijiao respond to Siwu Tang plus Huangbai and Zhizi, or Siwu Tang plus Fuping. Regulating water-dampness while treating blood deficiency is the highest method.
Sheng Dihuang treats epigastric hardness; Gan Dihuang does too, but less effectively.
During a cough epidemic in the capital, a patient unresponsive to various medicines was diagnosed by Hirono Taizhou as Kidney deficiency, failing with Bawei Wan. Left rib cramping led to prescribing Sini San plus Wuzhuyu and Muli, resulting in quick recovery.
A woman with days of spontaneous sweating, anorexia, leg cramps, and painful umbilical lump resembling postpartum consumption failed conventional treatment. Identifying the lump as primary, I gave Anzhong San. Lump dissipated, sweating stopped, full recovery.
Chronic abdominal pain unrelieved by dietary restrictions alone remains untreatable even if formula matches symptoms.
Abdominal pain with vomiting requires identifying cause before treatment; otherwise, error is common. Causes include: Accumulation/Masses (epigastric hardness, rebound tenderness); Food Stagnation (soft epigastrium, empty feel); Roundworms (gas sensation under finger); Water Retention (wandering pain, rumbling on pressure); Blood Stasis (periumbilical/lower abdomen, hard mass on pain); Intestinal Abscess (right abdomen, asymmetrical tenderness, moist painful limbs, right leg cramp, dribbling urine). Years of studying these six yield no errors.
Severe eye pain from wind responds to Zijuan (6-7 fen) inducing purging. (Zhuoxuan said: Did specialized ophthalmology ever possess such delightful methods?)
High fever from syphilis requires clearing/resolving. Incomplete resolution leads to chronic disability. Medical books omit this, a great pity.
Hemiplegia has treatable/untreatable distinctions. Patients unable to clasp hands are incurable. Testing supine hand-clasping reveals inability to maintain grip, a bad omen.
Forbidden-mouth dysentery involves water retention from stomach to epigastrium, causing strong movement at Shuifen. Fuzi Lizhong Tang plus Jingmi, or plus Shanyu/Shengjiang, works. Boiled chicken liver juice in sauce is also effective.
An 18-year-old merchant's daughter in Juehewan Tai street had mild measles unable to erupt, hidden in skin/flesh, high fever, vomiting, unable to take food/water. Attributing to internal heat toxicity, I prescribed Tiaowei Chengqi Tang, but illness prevented ingestion. Tian Xin Zang suggested bathing. Mixing rice wine with hot water in a basin, I bathed her, covered her to sweat. Vomiting stopped, rash erupted fully. (Zhuoxuan said: Wei's *Baoyuan Xinjian* salicylic acid bath for smallpox shares similar ingenuity.) Treating smallpox requires assessing stomach strength. Despite diarrhea, thirst, chills, grinding teeth, strong stomach qi allows treatment. Tonification vs. Purging depends于此.
Elderly persistent eczema often stems from dry blood and damp-heat steaming skin. Wenqing Yin is indicated, plus Fuping is good.
Severe moving qi in Hongxiangjiao may respond to Siwu Tang, using Shuifen movement as standard.
Hiccups originating in chest are treated with Chenpi, Zhuru, Dingxiang. Those in abdomen with Fuzi Jingmi Tang combined with Gancao Ganjiang Tang. If water retention with middle qi deficiency, Xiangsha Liujunzi Tang plus Shaoyao.
Postpartum anterior/posterior red/ulcerated mouth/tongue: Excess treated with Maimen Dong Jia Shigao Tang or Sanhuang Jia Shigao Tang. Mixed excess/deficiency with Jiawei Xiaoyao San. Extreme deficiency with Fuzi Tang plus Danggui. Red ulcers with white spots are bad omens; with diarrhea, incurable.
Pulses constantly changing in various diseases indicate Epilepsy.
I once stated: Shaoyao soothes Liver, Danggui moistens Liver, Chuanxiong disperses Liver, Sheng Dihuang drains Liver. Functions differ, yet all relate to Liver category.
Sudden collapse with responding Duyang pulse is a bad omen. Why? Stomach qi depletion causes counter-pulsation. Assess spirit presence. Vomiting and diarrhea differ in presentation but share cause; physicians must understand this.
Condensation in epigastrium often relates to Liver Qi. Epidemic conditions often involve Liver Qi; observe carefully.
Chiyou Dansdu (red wandering carbuncle) not purged early attacks internally becoming Zouma Yagan (gangrenous stomatitis); Liangge San plus Xijiao is appropriate.
Syphilis attacking head causing convex/concave swelling belongs to Fire syndrome. Wenqing Yin is appropriate. Syphilis stirring generates fire; do not treat merely as dampness.
Long-term patients sleeping only on one side who suddenly sleep freely face imminent death.
Ikeda Suisen (Jinqiao) examined smallpox roughly, appearing careless. Asked why, he said: Over-examination distorts truth. Skill lies in fleeting observation. Like watching an executioner; even the strong lose spirit briefly; prolonged staring makes them look normal. I treated the son of Lord Sugaya, who ate persimmons damaging stomach, causing severe vomiting/diarrhea, cold limbs past elbows/knees. Hundreds of prescriptions failed; waiting for death. Observing vitality, I gave Lizhong Anhui Tang; he revived. Previous doctors stared too long; I saw him briefly on the road. Suisen truly grasped reality.
Scrotal disease with leg wasting and bedridden state is mostly incurable.
Syphilitic chancres entering pupil causing depression/defect require mercury agents; no other drug works. Adjusting mercury dose restores pupil shape. If pupil remains small/tight with scattered spirit, it is incurable.
Deafness, blindness, or hoarseness resulting from syphilitic chancres are incurable. However, partial hearing loss may improve with distant medication.
Oral rot from Qingfen (calomel) responds to equal parts Pomegranate Peel and Pine Resin decoction.
When administering powder agents, giving fire-draining medicine first is better. Similar to treating trauma by removing water first, then applying wine for full effect.
Perineal trauma with urinary retention and slight hematuria responds to Taohe Chengqi Tang. If ineffective, one dose of Dahuang Fuzi Tang with 2 qian Fuzi is optimal, stopping urine flow and bleeding. Alternatively, Bawei Wan suits certain conditions, per Zhen Fujimoto's tested formula. (Zhuoxuan said: Severe perineal trauma with total urinary retention and hematuria requires harsh internal agents like Gansui/Daji and external catheterization; otherwise, no rescue. This item describes milder cases.)
Pi (accumulation) obstructing chest/diaphragm shows different pulses left/right. Pulse is choppy where Pi exists, rapid where it doesn't. Some with normally slow pulses become rapid due to Pi.
Pi patients lying horizontally may sleep with lower or upper Pi dominant. Lower Pi implies severe upward rushing in chest.
Pure red, soft tongue losing normal dryness indicates suitability for Renshen/Fuzi. Unchanged tongue color is a bad omen. No sweat, delirium, irritability...