度，群医遍药三百余剂，一无所效，访余求治，诊其脉六脉沉细已极，右关尺似有似
无，明系火衰土弱之至，肾家虚气，上凌于心，脾土衰微，不能按纳奔豚之气，非温何
以散之？乃立一方，用炒干熟地八钱，补水以滋土，炒黄白术六钱，补土以固中，炮姜
热附各二钱，补火以生土，但中宫既有阳和之气，而至阴实为纳气之乡，更入五味子一
钱以敛之，则主气有根而不拔，元阳深藏而有源，不失脏为藏纳之义，而肾尤为主纳不
出之司，故补气者不知补来藏纳至深主纳之脏，则药力一缓，必复涣散无归，盖四脏之
中，心以虚灵为事，肺以输降为功，肝以疏泄为能，脾以健行为用，其位其职，皆非克
能藏纳之地，是以五脏调和无过，则脏脏之气血精华，何一不输归于肾？及其失调既
病，而欲理气调元，或补气还元，及纳气藏元者，而欲舍肾，谁于与归，愚见如此。是
以令服前剂，三日而霍然逾半，一月而全安，要知平人而至于病，必由于水火二家先
病也。病至于人，必由于水火二道病极也。大至于危，必由于水火二气将脱也。故小病
或由于气血之偏，而大病必由于水火之害，治之者舍气血以治小病，舍水火以治大病，
真犹缘木求鱼，其可得乎！
工部李老先生相与最契，一日发热，牙床肿烂，舌起大泡，白苔甚浓，疼痛难忍，
医用清解之药，口舌肿烂益甚，数夜不寐，精神恍惚，野狼狈不堪，按其脉，两关尺甚
微，惟两寸少洪耳。余曰∶龙雷之火，亦能焚焦草木，岂必实热，方使口舌生疮乎，盖
脾元中气衰弱，不能按纳下焦阴火，得以上乘奔溃肿烂。若一清胃，中气愈衰，阴火愈
炽，急为温中下二焦，使火有所接引而退舍矣。乃用白术八钱、炮姜三钱、温中为君，
炒麦冬三钱，清上为臣，牛膝三钱、五味子一钱，下降敛纳为佐，附子一钱一分，直暖
丹田为使，如是数剂，精神渐复，口舌牙床肿者消而溃者愈矣。
正白旗左参领李公，年将六旬，患淋病二年，有时甚频甚利而且速，有时点滴难
通，急痛如刀割，肥液如脂膏，或成条紫血，举家日夜不安，病患时欲自尽，访余求
治，叩其前服之方，有一医立通利止涩二方，遇便频利则用止涩，遇便秘塞则用通
利，常将服通利之药，忽小便已通利无度矣。将服止涩之药，而小便已点滴难通矣。
病者医家相根据为苦，按其脉两寸太洪，余皆无力，独肝肾更甚，余曰∶肝主疏泄，肾主
闭藏，开阖自有专司，奚待药力为用哉！今因肝肾俱病，各废乃职，利则益虚其虚，涩
则愈增其滞，惟为调补肝肾，则各效乃职而自愈也。用八味加麦冬二钱、升麻八分、红
花四分，重用人参冲服，使清者升浊者降，瘀者化中气一足，升降自能，肝肾既调，开
阖得所，服之旬余，日渐轻强，后以生脉饮送八味丸四五钱，于空心午后，以归脾加减
服之而痊愈。
阴阳盛衰之道，诚为疾病安危之大关，况媾精化生男女，尤切阴阳之至理。余友金
绍老，因晨泻不已而就诊，按其脉，两寸关俱沉弱无力，两尺沉微更甚，余曰∶少年得
此，不惟晨泻小病难愈，更恐嗣育之间，多女少男矣。适伊芳许世兄偶至，亦索余诊，其
脉亦然，各道并连生数女而无子，余令以八味去丹皮、泽泻，加补骨脂三两、菟丝子四
两、五味子二两，早晚食前各服五钱。两友并即制服，半载之后，俱各生子，可见《精
要》云∶久服令人肥健多子，信不诬也。
都门海岱门外黄宅一婴儿，甫及五月，忽发抽掣窜引，角弓反张，一夜五次，遇发
则二便并出，额汗如雨，势甚危急，延余视之，亡阳之势俱备矣。询其由，乃因常生重
舌，屡服五福化毒丹，服后必泻数次即愈，殊不知虚阳，肆进苦寒，脾阳下元亏
极，肝木无养，挟火上乘，脾土益伤，虚风乃发，令以人参、白术各一钱，熟附四分，
三味煎服，服后安然静睡，下午复发，随服随安，病家见药之效，乃每日早进一服，精
神日长，其病竟瘳。所以贵乎认病无差，投药无误，岂可以纯阳之子执用苦寒哉！
庠生徐六御偶患疟疾不已，热时恶心，胸胀倍甚，医用柴胡汤加草豆蔻，意以其痰
食为患耳。孰知徐友素有鼻衄之症，今当壮热之时，忽遇辛热之药，迫血妄行，溃涌数
斗，昏晕不醒，冷汗如珠，四肢皆冷，脉微欲绝，余以独参两余，煎汁半钟灌之，始能
吞咽，再煎再灌，次日稍苏，但呃逆不止，乃以温补之药，重用人参冲服，诸症渐平，
精神渐长，但人参略少，呃逆便甚。凡八味丸、十全大补汤，早晚进服，将两月而痊
愈。
一李宅令郎八岁，病热旬余，发散和解，苦寒之剂，俱备尝而皆不效，势日危
笃，延余视之，形肉枯稿，牙齿堆垢，浓而焦黑，唇舌燥裂，耳聋目盲，遍体疼痛，壮
热无汗，谵语烦躁，及诊其脉沉微欲脱，阴寒之脉也。余曰∶此釜底无火，假寒干燥之
象，上之假热，由于下之真寒也。乃重用人参、熟地，少加附子壮水益火之剂，重培阴
中之水火。服后而热退，至夜半而思食，次日其脉更虚，但神气稍觉清爽，乃倍进前药
三四剂后，燥槁之势日消，困顿之势日减，饮食渐长，精神渐生，危笃沉 ，不十剂而
痊愈。
庠生王慎瞻，平时用心劳神太过，偶日远行劳顿，途中所食冷面羊肉，归家胸中疼
胀不堪，医所用者无非山楂、莱菔子、枳壳、浓朴之类，为肉面起见，立方而已，服
之而益甚，渐至心如压扁，昏晕闷绝，少减则苏，群医不效，乃延余治。余曰∶食乃有
形之物，惟入肠胃，滞则为胀为疼，着而不移，岂有有迹之物，而能升降胸次乎？盖胸
为心肺之部，止受无形之气，不能藏有形之物也。具六脉弦细而数，身不热而语言无
力，皆非伤食之候，乃积劳元神大伤，无根之气，上逆于心，以致胀痛不堪也。当以塞
因塞用之法，乃以枣仁、乳香、朱砂为细末，新剖猪心血为丸，用人参五六钱，煎浓
汤送服，少顷令以莲子煮白米粥压之，奈病患苦干疼胀，能药而不能食，尊翁乃欲跪而
求之，病患勉吞粥半碗，如是数日，疼胀渐减，继而胸膈自觉甚空，虽多食不饱，烂肉
干饭，饱食多日，究竟大便，所出无几，病家始知平时劳碌太过，脏腑脂膏耗竭，致如
中消之势，食物入腹，消烁无余，所以入多出少，从前之疼胀，乃脱气上浮之虚胀也。
宝坻崔姓，六脉沉微，身热四肢逆冷，发狂谵语，连夜不寐，口渴浩饮，二便俱
秘。余曰∶阴伏于内，逼阳于外，因津液不行，故小便秘而口干渴，非实热也。因谷食
久虚，故大便虚秘不通，非燥结也。若不急为敛纳，则真阴真阳并竭矣。乃用熟地、炒
麦冬以壮金水，炒白术以托住中气，牛膝、五味子下趋藏敛，制附子以引火归源，另重
用人参煎汁冲服，不三剂狂定神清，思食而愈。又保定府王姓，症候脉气固前，但更兼
泄泻不止。余曰∶脾肾两败，火无所藏之地，盖火之所藏，在水土之中也。急用温补
中下，使龙雷得所藏之宫，乃重用白术直固中气为君，人参保元接续为臣，炮姜暖中以
助健行，五味子酸收以使闭藏，并以为佐，附子下走，气猛温中，性雄为使，又恐下走
太速，中官不受其益，入炙草少缓于中。如是三四剂，诸症渐平，神气清爽矣。然此
方不用熟地、麦冬者，因有泄泻走泄阳气之端，恐略滞阴寒之味，则炮姜、术附补阳之
力反缓矣。何前方不用炮姜炙草者？盖欲熟地、麦冬滋补真水。若兼炮姜、炙草中宫之
药，则不能达下，且熟地甘温濡润之品，杂入辛热，炮姜、炙草温中之药，则不但濡润
滋肾之性全失，而熟地毫无着落矣。故地黄丸从无加芎归、炙草、炮姜也。前方二者，
一以专补脾肾之阳，一以兼救脾肾之阴耳。
凡论人元气，不拘在老少强弱，全以脉气为主。余治佟府母子俱病甚危，皆以不省
人事，其母年已六旬有余，外虽糊涂，独尺脉有根不疾不徐，余曰∶形体虽困，然先天
禀受根本甚浓，尚有发生之势，当无虞也。但脉气不热不寒，则药亦不宜偏寒偏热，仅
以人参五钱，煎浓汤饮之，和平保元，扶助发生可也。日进二次，继以粥汤，服三日而
始故，病家复有勿治之念矣。余曰∶五脏之传，七日而始遍，今才三日，未调其半，遽
望效乎，再强三日，渐觉苏醒，日渐康强而愈。其令郎年止三十，奈平素两尺最微，此
时发热数日，医者始用发散不效，继以和解亦不效，投以寒凉复不效，日渐昏倦，咽燥
口裂，语言谵妄，睡卧不宁，便溏遗，面赤惨黯，其脉两寸洪数，关弱而尺微已极，余
曰∶此劳伤发热之症，夫劳能伤中，力极伤肾，不为甘温，以敛浮越之阳，反用发散和
解寒凉，则上焦之元气得发散而愈虚，中焦之元气，得和解而愈弱，下焦之元气，得寒
凉而愈浮，今若不为托住正气，按纳虚阳，其可救乎？乃用人参保元，熟地滋阴，白术
固本，三味为君药，炒燥麦冬，用为舟楫，且饮气之主以注于肾为臣药，牛膝下引，五
味子敛纳为佐药，制附子直达丹田为使药。如是数服，渐得清爽，月余而愈，老者平补
效速、壮者峻补效迟，可见元气禀受不同，不在老少分也。
都门景姓室人，年近五旬，中风已五六日，汗出不止，自而口噤遗尿无度，医皆以
为坏症弃之，来延余视，诊其六脉虽甚微，而重按尚有不疾不徐，自然之势，此即胃气
也。余曰∶遗尿本为当时脱症而为坏候，若多日而不尿，有是理乎？坐视数日而不脱，
断非绝症也。投以参附汤二三剂，日渐轻强，后重服温补而愈。
信乎真水真火，实为生人之本，而为绝处逢生者也。余媳向患吐血夜热之症，自受
娠以来，八味丸加牛膝五味子者日服勿间，及至临月，无如胞水已下，数日而未生，余
按其脉，六脉洪弦而带坚体，此阴道枯槁已极，何能流通生育乎？投以补养血气催生之
药，脉候如故。余曰∶真阴真阳真气亏极，泛行调补气血之群药，功力不专，不足济其
至亏至要之处也。乃单以熟地三两，浓煎投服，日进三次，脉始洪缓而软，但坐产数
日，子母精力俱乏，故胎气竟不运动，毫无下达，稳婆众人疑以为死胎矣。余以人参五
钱，煎汤一钟，细刮肉桂最紫最甜最香者为末钱余，调入参汤服之，服后腹疼，胎下少
许，又服又然。如是者连服三四剂后，始能得生，其子既下，啼哭声许而不动，众亦以
为难生者矣，置之地间，适太阳光照，喷嚏声啼而活，犹火镜之晶光在内，始能借太阳
相射，便可从无形而化有形也。更悟《养生篇》曰∶火传也，不知其尽也。自古及今，
只是此火，火传而命续，由乎养得其极也。
海昌陈又老，以乡试在都，适患红白痢甚密，延余诊视，两寸略洪，两尺左关甚
弱，舌有黑苔，余曰∶肝不能疏泄，肾不能闭藏，宜痢症之重密，不待言矣。且真阴亏
极于下，真津燥槁于上，水乘火位，故赤舌变黑也。若服黄连益增其害，不意是夜果有
以香连进服，服后痢更无度，困顿将危，乃复延余治。余以八味汤大料，用人参冲服，
渐得轻强，调理月余而痊愈。
凡百病，须凭脉用药，不可拘执一方，泥于常法。如妇人妊娠之后，倘以古方条
芩、砂仁为事，奈近人禀受多虚。若脾元不足，六脉沉微者，而用条芩，则脾虚且寒，
胎欲下堕，焉可得乎？倘肾阴不足，六脉洪数者，而用砂仁，则水枯金燥，胎欲长养，
焉可得之？试思古人伤寒门中，妊妇大便燥结，里实热甚者，亦用酒制大黄转药，但兼
四物以护之，则无损于胎矣。盖以大寒大热之病，客之于身，不急为除去，反足以损
胎，因所因而投之，则有病病当，似乎有碍于胎，而实有益于胎，但中病即已，毋过其
制，《经》所云∶有故无损，亦无殒也。《经》注∶上无殒，言母必全。亦无殒，言
子亦不死也。又曰∶衰其大半而止，过者死，此之谓也。常治一妇，妊娠三月而大
吐，两月有余，药食俱不能受，六脉沉微已极，余竟照脉立方，以人参五钱、白术四
钱、炙甘草一钱、炮姜、制附子各一钱五分，投之数剂而愈，胎竟安然。更有寸强尺
弱，腹痛晨泻，虚火上炎，口干烦躁，饮食难化，腰疼腿软，上热下寒者，轻则八物肾
气丸，重则八味地黄丸，服之乃安，子母俱壮，是所谓应犯而犯，似乎无犯。若泥于桂
附堕胎之说，执而不用，反以苦寒，不亦误甚，合宜而用，药不执方，诚格言也。况补
阳而重用参术为之主持，则乘载有力，其熟附惟顺君药，温补脾元，焉能自展堕下之力
哉！且脾喜暖而恶寒，若久为阴寒所困，即胎元亦无生色，今得暖剂救援，则脾困得解
而健旺，胎亦籍此而有主机矣。至于六味八味二丸，胎闷用以补阴补阳，医实谆谆言之
详矣。况丸者，缓也。日渐吞服，脏腑习又为常，且有地茱重味阴药护之，而桂附惟有
煦濡长养上奉之益，焉有伤胎堕下之虞，惟脉洪大有力，血热胃强为患者，当从条芩、
...If Kidney Yin is insufficient and the six pulses are surging and rapid, using Amomum fruit (Sharen) would lead to dryness of Water and Metal, hindering fetal development. Consider that in ancient texts regarding Cold Damage, pregnant women with dry stool and severe interior excess heat were treated with Rhizoma Rhei Preparata (Dahuang) processed with wine, but this was always combined with Four Substances Decoction (Sì Wù Tāng) to protect the fetus, thereby causing no harm. Because pathogenic factors of extreme cold or heat lodged in the body, if not removed promptly, could indeed damage the fetus. By treating according to the cause, although it may seem detrimental to the fetus, it is actually beneficial. One must stop when the disease is half-cured and avoid overdosing; as stated in the *Classic of Internal Medicine* (*Huangdi Neijing*): "When there is a pathology, there is no injury, nor is there death." The commentary explains: "No injury above" means the mother will not die; "nor is there death below" means the fetus will not perish. It further states: "Reduce by more than half and stop; exceeding this leads to death," which refers to this principle.
I once treated a woman who suffered from severe vomiting during the third month of pregnancy. For over two months, she could not tolerate any medicine or food. Her six pulses were extremely deep and minute. I prescribed solely based on the pulse diagnosis: Ren Shen (Ginseng Radix et Rhizoma) 5 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 4 qian, Zhi Gan Cao (Prepared Licorice Root) 1 qian, Pao Jiang (Prepared Ginger Rhizome), and Zhi Fu Zi (Prepared Aconite Lateralis Radix) each 1.5 qian. After several doses, she recovered, and the fetus remained safe. There are also cases presenting with strong Cunkou (inch) pulses and weak Chi (cubit) pulses, abdominal pain with morning diarrhea, floating deficient fire, dry mouth and irritability, difficulty digesting food, lower back pain, weak legs, and symptoms of upper heat and lower cold. Mild cases respond to Ba Wu Shen Qi Wan (Eight-Ingredient Pill with Eight Herbs for Kidney Qi), while severe cases respond to Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill). Upon taking these, they stabilize, and both mother and child become robust. This is what is meant by "applying contraindicated treatments appropriately"; it appears to violate rules but does not. If one rigidly adheres to the notion that Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite) cause abortion and refuses to use them, resorting instead to bitter-cold herbs, is this not a greater error? Using medicines appropriate to the condition without sticking to fixed formulas is indeed a golden rule. Moreover, when tonifying Yang, heavy use of Ren Shen and Bai Zhu provides sufficient support; Shu Fu Zi (Prepared Aconite) merely follows the sovereign herb to warm and tonify the Spleen Yuan. How could it independently exert an abortifacient effect? The Spleen prefers warmth and dislikes cold. If trapped by yin-cold for a long time, even the fetal origin lacks vitality. Now, aided by warm remedies, the Spleen's stagnation is resolved and becomes vigorous, allowing the fetus to gain its driving force. Regarding Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Ba Wei Di Huang Wan, used for fetal restlessness to tonify Yin and Yang, physicians have discussed this in detail. Furthermore, pills act slowly; daily ingestion allows the zang-fu organs to adapt. Protected by heavy Yin herbs like Di Huang (Rehmanniae Radix) and Shan Zhu Yu (Corni Fructus), Gui Zhi and Fu Zi only offer benefits of warming, moistening, nurturing, and ascending. Where is the danger of harming the fetus or causing abortion? Only patients with surging, large, and forceful pulses, indicating blood heat and strong Stomach fire, should use Tiao Qin (Scutellariae Radix)...