大尹沈用之,不时发热,日饮冰水数碗,寒药二剂,热、渴益甚,形体日瘦,尺脉洪大而数,时
或无力。王太仆曰∶热之不热,责其无火;寒之不寒,责其无水。又云∶倏热往来,是无火
也;时作时止,是无水也。法当补肾,用加减八味丸,不月而愈。
通安桥顾大有父,年七十有九,仲冬将出,少外家入房,致头痛发热,眩晕,喘急,痰涎壅盛,小
便频数,口干引饮,遍舌生刺,缩敛如荔枝然,下唇黑裂,面目俱赤,烦躁不寐,或时喉间
如烟火上冲,急饮凉茶少解,已滨于死。脉洪大而无伦,且有力,扪其身,烙手,此肾经虚火
游行于外,投以十全大补加山茱、泽泻、丹皮、山药、麦门、五味、附子。一钟熟寐良久,
脉症各减三四,再与八味丸,服之诸症悉退,后畏冷物而痊。
下堡顾仁成,年六十有一,痢后入房,精滑自遗,二日方止。又房劳感寒,怒气遂发寒热,右胁
痛连心胸,腹痞,自汗、盗汗如雨,四肢厥冷,睡中惊悸,或觉上升如浮,或觉下陷如堕,遂
致废寝,或用补药二剂,益甚,脉浮大洪数,按之微细,此属无火虚热,急与十全大补加山药
、山茱、丹皮、附子。一剂诸症顿愈而痊。此等元气百无一二。(二顾是父子也)。
一儒者,口干,发热,小便频浊,大便秘结,盗汗,梦遗,遂致废寝,用当归六黄汤二剂,盗汗顿
止,用六味地黄丸,二便调和,用十全大补汤及前丸兼服,月余悉愈。
州同韩用之,年四十有六,时仲夏,色欲过度,烦热作渴,饮水不绝,小便淋沥,大便秘结,唾
痰如涌,面目俱赤,满舌生刺,两唇燥裂,遍身发热,或时如芒刺而无定处,两足心如烙,
以冰折之作痛,脉洪而无伦,此肾阴虚,阳无所附而发于外,非火也。盖大热而甚,寒之不
寒是无水也。当峻补其阴,遂以加减八味丸料一斤内肉桂一两,以水顿煎六碗,冰冷与饮
,半饷已用大半,睡觉而食温粥一碗,复睡至晚,乃以前药温饮一碗,乃睡至晓,食热粥二
碗,诸症悉退。翌日畏寒,足冷至膝,诸症仍至,或以为伤寒。余曰∶非也,大寒而甚,热
之不热,是无火也。阳气亦虚矣,急以八味丸一剂服之稍缓,四剂诸症复退。大便至十三日
不通,以猪胆导之,诸症复作,急用十全大补汤数剂方应。
举人陈履贤,色欲过度,丁酉孟冬发热无时,饮水不绝,遗精不止,小便淋沥。或用四物、芩
、连之类,前症益甚,更加痰涎上涌,口舌生疮。服二陈、黄柏、知母之类,胸膈不利,饮
食少思。更加枳壳、香附,肚腹作胀,大便不实,脉浮大按之微细。余朝用四君为主,佐以
熟地、当归,夕用加减八味丸,更以附子唾津调搽涌泉穴,渐愈。后用十全大补汤,其大便
不通,小腹作胀,此直肠干涩,令猪胆通之,形体殊倦,痰热顿增,急用独参汤而安,再用
前药而愈。但劳发热无时,其脉浮洪,余谓其当慎起居,否则难治。彼以余言为迂,至乙巳
夏复作,乃服四物、黄柏、知母而殁。
吴江晚生沈察,顿首云云∶仆年二十有六,所禀虚弱,兼之劳心,癸巳春发热吐痰,甲午冬为
甚,其热时起于小腹,吐痰而无定时,治者谓脾经湿痰郁火,用芩、连、枳实、二陈,或专
主心火,用三黄丸之类,至乙未冬其热多起足心,亦无定时,吐痰不绝,或遍身如芒刺然。
治者又以为阴火生痰,用四物、二陈、黄柏、知母之类,俱无验,丙申夏,痰热愈甚,盗汗,
作渴。果属痰火耶?阴虚耶?乞高明裁示云云。余曰∶此症乃肾经亏损,火不归经,当壮水之主
,以镇阳光。乃就诊于余,果尺脉洪大,余却虚浮,遂用补中益气及六味地黄而愈。后不守
禁,其脉复作,余谓火令可忧,当慎调摄,会试且缓,但彼忽略,至戊戌夏,果殁于京。
Shen Yongzhi, a Da Yin (Chief Magistrate), experienced intermittent fever. He drank several bowls of ice water daily and took two doses of cold-natured medicines, yet his fever and thirst worsened, and his body became increasingly emaciated. His Chi pulse (Kidney pulse) was surging and rapid, yet sometimes weak. Wang Taipu stated: "If heating treatment fails to produce warmth, the fault lies in the lack of Fire (Kidney Yang deficiency); if cooling treatment fails to produce coolness, the fault lies in the lack of Water (Kidney Yin deficiency)." He further said: "Sudden alternating hot and cold indicates the absence of Fire; symptoms that come and go indicate the absence of Water." The method should be to tonify the Kidney, using Jiajian Bawei Wan (Modified Eight-Ingredient Pill). He recovered in less than a month.
The father of Gu Dayou from Tong'an Bridge, aged seventy-nine, engaged in sexual intercourse shortly before going out in mid-winter. This resulted in headache, fever, vertigo, panting, excessive phlegm-saliva, frequent urination, dry mouth with desire to drink, prickles all over the tongue causing it to shrink like a lychee pit, black cracking of the lower lip, redness of the face and eyes, irritability, insomnia, and a sensation of fire/smoke rushing up the throat. Drinking cool tea provided slight relief, but he was near death. His pulse was surging, chaotic, and forceful; his body felt burning hot to the touch. This was deficient Fire of the Kidney channel wandering on the exterior. He was administered Shiquan Dabu Tang (Complete Great Tonifying Decoction) added with Cornus officinalis Fruit (Shanzhuyu), Alisma Rhizome (Zexie), Moutan Cortex (Danpi), Dioscorea Rhizome (Shanyao), Ophiopogon Tuber (Maimendong), Schisandra Fruit (Wuweizi), and Aconite Lateral Root (Fuzi). After one dose, he slept soundly for a long time, and his pulse and symptoms each decreased by three or four tenths. He was then given Bawei Wan (Eight-Ingredient Pill), after which all symptoms subsided. He eventually recovered, becoming averse to cold objects.
Gu Rencheng from Xiabao, aged sixty-one, had sexual intercourse after dysentery, resulting in seminal emission, which stopped only after two days. Subsequently, due to sexual fatigue and exposure to cold, combined with anger, he developed chills and fever, pain in the right hypochondrium radiating to the chest and heart, abdominal fullness, spontaneous sweating, and night sweats profuse as rain. His limbs were cold, he experienced palpitations during sleep, and sensations of floating upwards or falling downwards, leading to neglect of food and rest. Two doses of tonifying medicines taken by others worsened his condition. His pulse was floating, large, surging, and rapid, but fine and subtle upon deep pressure. This belonged to deficient heat without Fire. Urgently, he was given Shiquan Dabu Tang added with Dioscorea Rhizome (Shanyao), Cornus officinalis Fruit (Shanzhuyu), Moutan Cortex (Danpi), and Aconite Lateral Root (Fuzi). After one dose, all symptoms resolved, and he recovered. Such cases of severe Yuan Qi (Original Qi) deficiency are rare, one in a hundred. (These two Gu men were father and son.)
A scholar presented with dry mouth, fever, frequent and turbid urination, constipation, night sweats, and nocturnal emissions, leading to neglect of food and rest. He was given Danggui Liuhuang Tang (Angelica Hexapartite Decoction) for two doses, after which night sweats ceased immediately. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was used to harmonize bowel movements and urination. Shiquan Dabu Tang and the aforementioned pill were taken concurrently, and he fully recovered after more than a month.
Han Yongzhi, a Zhou Tong (Assistant Prefect), aged forty-six, in mid-summer, suffered from excessive sexual indulgence, resulting in vexatious heat, thirst, incessant drinking, dribbling urination, constipation, profuse sputum, redness of the face and eyes, prickles all over the tongue, dry cracked lips, generalized fever, occasional pricking sensations without fixed location, and soles of feet feeling like they were branded. Even breaking ice caused pain. His pulse was surging and chaotic. This was Kidney Yin deficiency, where Yang had no anchor and floated outward; it was not excess Fire. Generally, extreme heat that does not respond to cold indicates lack of Water. One must severely tonify Yin. Thus, Jiajian Bawei Wan ingredients (one jin) were mixed with Cinnamon Twig (Rougui, one liang), decocted once in water to yield six bowls. It was given cold to drink. In half a meal's time, more than half was consumed. Upon waking, he ate a bowl of warm porridge, then slept until evening, drank a bowl of the medicine warm, and slept until dawn, eating two bowls of hot porridge. All symptoms subsided. The next day, he feared cold, his feet were cold to the knees, and symptoms returned. Some thought it was Shanghan (Cold Damage). I said, "No. Extreme cold that does not respond to heat indicates lack of Fire. Yang Qi is also deficient." Urgently, one dose of Bawei Wan brought slight relief; four doses made symptoms recede again. Constipation persisted until the thirteenth day; pig bile suppository was used, causing symptoms to recur. Urgently, several doses of Shiquan Dabu Tang were required to resolve it.
Chen Luxian, a Juren (Graduate), suffered from excessive sexual indulgence. In early winter of the Dingyou year, he had irregular fever, incessant drinking, continuous nocturnal emissions, and dribbling urination. Treatment with Siwu Tang (Four Substance Decoction), Scutellaria Root (Qin), and Phellodendron Bark (Lian) worsened previous symptoms, adding surging phlegm-saliva and mouth/tongue ulcers. Taking Erchen Tang (Two-Aged Decoction), Phellodendron Bark (Huangbai), and Anemarrhena Rhizome (Zhimu) caused chest/epigastric discomfort and poor appetite. Adding Bitter Orange Peel (Zhiqiao) and Cyperus Rhizome (Xiangfu) caused abdominal distension and loose stools. His pulse was floating and large but fine/subtle upon pressure. In the morning, I used Sijunzi Tang (Four Gentlemen Decoction) as the main formula, assisted by Prepared Rehmannia Root (Shudi) and Angelica Sinensis Root (Danggui). In the evening, Jiajian Bawei Wan was used. Additionally, Aconite Lateral Root (Fuzi) mixed with saliva was applied to Yongquan (KI 1). Gradually, he improved. Later, Shiquan Dabu Tang was used. When constipation and abdominal distension occurred due to rectal dryness, pig bile was used to unblock him. His physique became extremely fatigued, and phlegm-heat suddenly increased. Urgently, Ginseng Single Herb Decoction (Dushen Tang) stabilized him, followed by previous medicines for recovery. However, regarding irregular fever from labor with a floating/surging pulse, I advised careful daily regimen management, otherwise it would be difficult to treat. He considered my advice pedantic. In summer of the Yisi year, it relapsed. He took Siwu Tang, Phellodendron Bark, and Anemarrhena Rhizome and died.
Shen Cha, a junior scholar from Wujiang, bowed and said: "I am twenty-six years old, constitutionally weak, and have labored my mind. In spring of the Guisi year, I had fever and expectorated phlegm; in winter of the Jiawu year, it worsened. The heat originated from the lower abdomen, with irregular expectoration. Physicians attributed it to damp-phlegm and stagnant fire of the Spleen channel, using Scutellaria Root, Phellodendron Bark, Immature Bitter Orange, and Erchen Tang. Or they focused on Heart fire, using Sanhuang Wan (Three Yellow Pill). By winter of the Yiwei year, heat often originated from the soles of the feet, irregularly, with continuous expectoration and generalized pricking sensations. Physicians attributed this to yin-fire generating phlegm, using Siwu Tang, Erchen Tang, Phellodendron Bark, and Anemarrhena Rhizome, without effect. In summer of the Bing Shen year, phlegm-heat worsened, with night sweats and thirst. Is it truly phlegm-fire? Or yin deficiency? I beg your high wisdom to adjudicate." I said: "This condition is Kidney channel deficiency with Fire not returning to its source. One must strengthen the Master of Water (Kidney Yin) to suppress the Sunlight (Deficient Fire)." Upon examination, his Chi pulse was surging, while other pulses were deficient and floating. He was treated with Buzhong Yiqi Tang (Middle-Joint Boosting Qi-Enhancing Decoction) and Liuwei Dihuang Wan, and recovered. Later, failing to observe dietary/lifestyle restrictions, his pulse returned. I warned that the Fire season was concerning and advised careful regulation, suggesting postponing the metropolitan examination. He ignored this. In summer of the Wuxu year, he indeed died in the capital.