标可求其本。即如此案中列症云寒热往来。又云六脉弦数。则已明明绘出肝虚燥痛一症供状矣。
临症者自不察耳。然脉症具在。识者固自胸中了了也。
一妇患内伤症。值孕八个月。身体壮热。口渴。舌胎焦黑。医用寒凉治之。予曰。无论内伤。
即麻黄桂枝症。也
须先安胎。后攻邪。今两手脉数大无伦。虚热盛极。乃复用寒凉。阳受阴逼。其能久乎。投以滋
肾生肝饮。一剂热退。继用补中益气汤而愈。症曰内伤。则一补中益气。足以治之矣。而先之以
滋肾生肝者。盖症见壮热口渴。舌胎焦黑。脉见数大无伦。则阳邪燔灼。脉已无阴。不先救以甘
温滋润之品。而遽投参 升补之剂。则阳火愈旺。而阴愈受伤矣。因为拈出。以告世之不识先后着
者。壬寅九月中。至海昌。封翁杨乘六延予诊脉。并子弟四五人遍诊之。其次郎在公者。六脉动
甚。因语曰。兄脉紧而弦。往来无韵。不出一月。危病至矣。为之定方而别。斯时无甚病。其家
不之深究。十月中。忽患咳嗽。痰中见血。医作风寒症治。数以羌防发散与之。十余日。遂大吼
喘。痰涌如潮。作 声。不得卧。坐一人床上。以额俯靠其背。稍抬头即喘急欲死。走人至杭
邀予。予诊之曰。以前日脉推之。病根固深。然不宜困败如此之速也。此殆攻伐之药逼成之耳。
无救矣。奈何。病家哀恳。言不幸而先生之言中。今时刻难过。生死且不暇计。得喘息稍苏。
又作区处。予曰。定喘不难。无如脉色皆去。纵喘定之后。仍虚脱而死耳。遂朝用参 归芍。暮
用加减八味。三日而能卧。饮食倍进。其家喜甚。以为得生。予曰。出入废则神机化灭。升降息
则气立孤危。今出入升降。俱废息矣。纵挽回何所施。兹不过暂接命门一丝未断之气。逾十日必
死矣。无能
为也。已而果然。向使病未见之先。即已见之后。医能以大剂填补峻补之药投之。即不能如备。
尚可稍延岁月。不至若是之促耳。此可为庸医妄肆攻伐之戒。
徐次 案。定死期于一年之后。此案则决危病于一月之前。以其六脉弦紧无韵而皆动也。乃
其期有远近者。以其脉之动有甚与未甚耳。两案合参。愈见四明指下之神。徐彦为子。甫四岁。
盛夏发热。惊搐不已。腰曲目直。小便短赤。面无神色。医作伤寒治。不应。邀予视之。予曰。
火燥生风。风淫末疾。非伤寒也。用滋水清肝饮。尽一剂而汗解便利热退。予曰。疟至矣。翌日
果然。立用五味异功散。加麦冬五味。十余剂而愈。每验小儿惊症。产后痉症。以及类中风症。
悉属火燥生风。而伤寒一症。尤多火燥生风者。盖因火燥而后风生。风从内出。非自外来。所以
为风淫末疾也。医家若不知其风从火出。而杂用羌防辛芷劫风燥血之剂。则火得风而转烈。阴被
燥而必亡矣。只看案中列症。先曰发热。次及惊搐。便见非热不生风。非风不发搐。然其发热之
由。总为肝肾阴虚所致。其腰曲者。肾水亏也。其目直者。肝血燥也。且肾合膀胱。肝主疏泄。
未有肝肾阴虚而小便犹能清利者。症虽蜂起。其实蝉联。标有不同。其本则一。类如是也。学人
须知其审症一毫不爽处。始知其处方一线不走处。若第用疏肝益肾及滋肾生肝等剂。非不对症。
然尚有一膜之隔也。细按自知。
毗陵董缙风。寓湖上。一仆患热症。遍体壮热。烦躁作渴。医作
伤寒治。予曰。发散寒凉。逼成外热。内转虚寒甚矣。急用补中益气汤加炮姜。一服而汗解热除
。再服而饮食进。三服而安。内真寒而外假热。乃长洲所发内经微旨也。然如此等症。最易辨却
最难辨。如列症云遍体壮热。烦躁作渴。则已俱是火症。何遽知其内属虚寒乎。盖以症属外感。
则未有既经发散。而反遍身壮热者。内果实热。则未有既服寒凉。而反烦躁作渴者。惟其症虽似
乎外盛。而实本于内伤。所以发散则亡阴。外虽似乎实热。而内本属虚寒。所以寒凉则灭火。然
则其为阴盛于内逼阳于外也。凡有理解者。俱可臆度得之。况深究内经之精蕴者哉。
吴章成弟。八岁。发热闷乱。大便不通。医作外感治。予曰。此得之伤食。因发散太过。遂
成虚热。兼风药燥血。故不便耳。先以六味饮加肉苁蓉三钱。饮之下黑矢十数枚。继以补中益气
汤。数剂而诸病悉除。伤食则气阻而脾不能运。斯时若以六君补中等剂。少加枳桔。助脾以消食
。则气通脾运。而发热便秘等病预却矣。治者乃误认为外感。而妄加发散。则阴虚血燥。肠胃干
枯。所伤之食。因愈秘而不出。设再遇粗工。吾知非倍进硝黄。即重用枳朴耳。岂能以滋肾润肠
之剂。使阴血濡润而燥矢自下哉。今而后
凡只求一便矢以毕其技能者。请以熟地苁蓉代硝黄枳朴可也。幸勿膺东庄所称矢医之荣号也。
一乡人力田辛苦。复饥甚饮食骤饱。倦卧半响。醒后忽喑哑不言。如是者二十余日矣。就予
诊之。予曰。劳倦伤脾。饥饱伤胃。阳明之气。遏而不升。津液不行。贲门拥涩。故语言不能出耳
。以补中益气汤十大剂与之。偶午睡觉。通身汗下。言语如常。以补中益气治喑哑不言。而于喉
舌置之不理。罔不共诧。为异矣。讵知亦甚无奇哉。只是窥破受病之源耳。然则何病不有其源。
而治病者。顾乃昧昧焉。而竟不为之寻耶。
一乡人患发背。上距风府。下连肾俞。通块肿起。肌肉青冷。坚硬如铁。饮食俱废。不省人
事。医犹用解毒药。予诊之。六部细数。气血大亏。毒将内陷矣。急用养荣汤。加附子炮姜。三大
剂而胃气开。十剂而坚硬者散去十之八九。只留左边如茶钟大。 红作痛。予戒之曰。切莫箍药
及刀针。气血温和。毒当自出。箍则反迟。非时而刺。收口难矣。彼以不任痛。竟受刺出血。予
曰。当倍前药急服。以收口为度。仍戒以节嗜欲慎饮食。兼服还少丹八味丸等药而愈。症有内外。
理无彼此。彼专治外症而不懂内症者。必其并不明于外症者也。故此症若一经外科粗技。则惟有
败毒药以消肿。破气药以开胃耳。宁能顾其本之亏与不亏。毒之陷与不陷哉。四明内外泛应。
无不曲当。由其脉症分辨处。无不清晰。更由其内外合一处。无不贯彻也。曹远思内人。月水不
至四月矣。腹痛不止。饮食少进。医作胎火治。予曰。此郁血也。然气禀怯弱。当补而行之。用
八珍汤三大剂。果下血块升许。腹痛犹未除也。以大剂养荣等药调理。而痛除食进。第九案中鲜
血奔注。反以去蓄之药利之。此症瘀血郁蓄。反以补血之剂行之。时而攻人之所不敢攻。时而补
人之所不敢补。洵非有胆者不能。尤非有识者未及也。
徽人江仲琏。冒寒发热。两颌拥肿如升子大。臂膊磊块无数。不食不便。狂躁发渴。诊其脉
浮数无序。医作伤寒发毒治。予曰误矣。此燥逐风生也。用大剂疏肝益肾汤。熟地加至二两许。
五剂而肿退便解。十剂而热除食进。再用补中益气汤加麦冬五味调理而痊。冒寒发热者。火为寒
邪所郁也。郁久则血为火迫。而变生燥症矣。然同一燥症。而于徐彦为之子。则用清肝者。以彼
有小便短赤一症也。夫赤为手少阴本色。而见于小便。则心火亢甚而达于膀胱矣。故用六味以滋
肾。而加柴栀归芍以清肝。滋肾者滋夫火之所由制也。清肝者清夫火之所自生也。尤妙在山栀枣
仁二味。盖心火既下逼膀胱。而不有屈曲下行之山栀。何以因其势而利导之。以泄心经之燥火哉
。且本经之阳火既亢。则阴气必亏。不有枣仁。又何以使归地之阴。敛而纳诸包络之中。以滋心
经
之阴气哉。夫立方各有其旨。用方必求其当。知彼案用滋肾清肝之妙。则此案用疏肝益肾之妙。
亦可见矣。
徐大千孙女。十余岁。发热数日。颈项牵绊疼痛。二便不利。忽四鼓厥逆。两目上窜。气喘
口噤。牙关不开。予诊之。病自太阳传阳明。今传少阳。甲乙兄妹。遂传厥阴耳。语其家人曰。
幸年小可救也。急以麻黄附子细辛汤。一夜尽三剂而始苏。五鼓能言矣。次用小柴胡汤合泻心汤
等药。调理而愈。
凡从阳经传阴经者。不作阴症。仍从阳经中治。四明治感。据症辨经。按经用药如此。仲景
真不死矣。杭人沈孟嘉妻。患吞酸膈痛屡年矣。肌肉枯削。几于绝粒。予诊之。六脉细数。此肝
木乘脾土也。先投六君子汤加炮姜。十余剂觉吞酸减半。继用补中益气汤加半夏炮姜。十余剂而
吞酸尽去。膈痛亦除矣。次用归脾汤倍加木香炮姜吞八味丸而愈。
木曰曲直。曲直作酸。故凡酸症。悉属肝木。以酸为木气也。然此症在他人。则混入逍遥左
金疏肝滋肾等症去矣。四明乃从六脉细数中。看出肝木乘脾。而用六君补中等剂。以培脾土。并
加炮姜之辛。以制肝木之酸。复用归脾八味。补火生土。以善其后。试问今人临症。谁则能如此
之分明不爽耶。
吕仲嘉内人。在室十四岁时。病寒热往来。迨后适仲嘉。又十余年。寒热如故。或作疟治。
或作虚治。 羸枯
削。几于骨立。延予诊之。予曰。此非疟非虚。乃血风症耳。以五加皮散加熟地二两。每剂共药
五六两许。水二升浓煎一升。每日尽一剂。如是者二十剂。而寒热顿除。此案症治。原从准绳中
脱胎来者。然如此审症。非独具有只眼不能。
吴维师子。甫十岁。发热口渴。胸腹闷痛。予曰。少阳阳明症也。用加味小柴胡汤。是夜发
晕逾一二时。维师惊甚。予曰。无伤也。但此病不传疟。必传痢。逾三日热退。果少腹痛。先解
黑矢无数。随后便脓血而痢矣。连用当归解毒汤。五六剂而痢除。继以六君子汤调理而安。胸痛
发热。少阳症也。口渴腹闷。则为阳明症矣。疟发寒热。少阳症也。便痢脓血。则为阳明症矣。
然症尚未来。四明何自而知之。盖以症属两经合病。则可知邪并于少阳。自当传疟。毒归于阳明
。自当传痢。其所以不传疟而传痢者。则以小柴胡汤乃少阳之的剂也。服后既见发晕。则少阳之
邪。业经汗散。特以正不胜邪。故不能托之尽出耳。然即有未尽。而既逾三日。则已由经入府。
而于少阳无与矣。尚何传疟之有哉。故知将来流病。前辈亦只是就现下本病。根据经据理而断之。
非率胸臆妄希偶中也。学人于此等处。果肯做个题目。仔细入思议来。则因此识彼。久则后来亦
可居上矣。谁谓古今人竟不相及也。范中行自省归石门。感冒风寒。又过于房劳。发热昏闷。
医以为伤寒也。羌活柴胡。投之不应。又以为阴症
也。肉桂木香。投之又不应。热且愈甚。饮食俱废。舌黑如炭。八日不便。医正议下。予往诊之。
脉细数而沉。因语之曰。阴亏甚矣。胃气将绝矣。非温和甘润之剂。弗能救也。急以左归及滋
水清肝等药。重加参 服之。他医以为不大便奈何议补。予曰。子以为承气症耶。误矣。第服药
自得便。至第四日果下黑矢升许。热退。舌亦红润。但尚未进食。病家犹以用补为嫌。予慰之曰
。本内伤症。一补中益气疗之足矣。无奈粗工杂投。胃气转伤。不能即复。今以药补之。以稀粥
调之。不过数日。自然知味。公等勿忧。病家不信。另延一医。重用承气汤。服至二剂。不得便。
病势反剧。无颜再恳予。往禾中延薛楚玉。楚玉至。病家叙述病情及用药次第。楚玉曰。既用熟
地而便。效可知矣。何至举将收之功而弃之耶。今无能为矣。逾数日果殁。病家目楚玉为予党。
究不之信。嗟夫。举天下学问之人。而尽目之为党。为彼之医。不亦难乎。
此等症。一则败于医药之乱投。一则败于主见之不定。遂举将收之功而尽弃之。良可惋惜。然
病者既因劳力致感。而又过犯房劳。则亦是自就死地也。悬此以为轻生好色者戒。
老友徐五宜之从侄次 。病咳嗽。予细诊其脉。六部皆动。心窃疑之。因问君嗜酒乎。曰然
。又问君得毋服天麦门冬生地知母贝母等类乎。曰服逾斤许矣。予曰。君病与此等药相反。可禁
勿服。写归脾汤六味丸两方与之。予归与用晦语曰。次 病。即素问所谓二阳之病发心脾也。其
人必劳心过度。又嗜酒多欲。急
救三阴。乃为良法。医以阴寒逼之。火无所泄其怒。遂成燎原之势。今六脉纯是阴火。有出无入
。不逾年死矣。是时座上有数客。皆惊曰。次 无恙。不过患伤风。何遽至是。予曰。脉法当如
是耳。八月中。予适与用晦寓孤山。次 邀予至天竺。曰。闻子善太素。乞为我诊。辛丑可得第
否。予曰。太素两字。出在三坟。后人窃之。以欺天下之耳目。且造为歌诀。妄言祸福。轩岐无
是也。但素问自有一种荣枯寿天贫富贵贱得失成败之说。要不出乎圣人吉凶悔吝善恶逆从之理。
其道甚微。然我能约略言之。诊毕。予语之曰。辛丑固好。然不若甲辰更得当也。次问寿。予曰
。子年甫三十外。不必问寿。予察其意。惟以科名为急。不及病情。似难直言。其尊人大千公。
忠浓长者。过予极浓。急返石门往告曰。令郎脉气不佳。如北上其不返乎。公何不阻其行。曰。
The superficial manifestations (Biao) can be traced back to their root cause. Just as in this case where the symptoms listed include alternating chills and fever, and the pulse is wiry and rapid in all six positions, it clearly depicts the condition of Liver deficiency with dryness and pain.
It is merely that the attending physician failed to observe carefully. However, since the pulse and symptoms are present, a knowledgeable practitioner would naturally understand it clearly.
A woman suffered from an internal injury syndrome while pregnant for eight months. She had high fever, thirst, and a black, scorched tongue coating. The physician treated her with cold-natured herbs. I said: Regardless of whether it is an internal injury, even if it were a Ma Huang Gui Zhi Tang pattern (Exterior syndrome of Taiyang), one must first calm the fetus before attacking the pathogen. Now, both wrists show a rapid and large pulse without limit, indicating extreme deficient heat. To use cold-natured herbs again will force Yang Qi under Yin pressure; how can it last? I administered Zi Shen Sheng Gan Yin (Nourish Kidney and Generate Liver Decoction). After one dose, the fever subsided. Subsequently, using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), she recovered. Since the syndrome is internal injury, Bu Zhong Yi Qi Tang alone would suffice. However, Zi Shen Sheng Gan Yin was used first because the symptoms of high fever, thirst, and black tongue coating, along with the rapid and large pulse, indicate blazing Yang pathogenic factor and depletion of Yin fluids in the pulse. Without first saving Yin with sweet-warm and moistening agents, and hastily administering Ginseng Radix et Rhizoma (Renshen) and Cimicifugae Rhizoma (Shengma) to tonify and raise Qi, the Yang fire would intensify, further injuring Yin. Therefore, I highlight this to warn those who do not understand the sequence of treatment.
In the ninth month of Ren Yin year, I arrived at Haichang. Feng Weng Yang Chengliu invited me to diagnose his pulse and that of four or five young men in his family. The second son, Zaigong, had very active pulses in all six positions. I told him: Your pulse is tight and wiry, lacking rhythm in its movement. Within a month, a critical illness will arise. I prescribed a formula and took my leave. At that time, he had no serious illness, and his family did not investigate deeply. In the tenth month, he suddenly developed coughing with blood in the sputum. Physicians treated it as Wind-Cold syndrome, frequently administering Qiang Huo (Notopterygii Rhizoma) and Fang Feng (Saposhnikoviae Radix) for dispersal. After more than ten days, he suddenly roared with wheezing, sputum gushing like a tide, making sounds, unable to lie down. He sat on a bed, leaning his forehead against another person's back; raising his head slightly caused suffocating asthma. A messenger was sent to Hangzhou to invite me. Upon diagnosis, I said: Based on the pulse from previous days, the root of the disease is indeed deep, but it should not have deteriorated so rapidly. This is likely caused by the forcing effect of attacking medications. There is no cure. What can be done? The family pleaded, saying unfortunately your words came true. Time is hard to pass, life and death are not yet considered; we only seek slight relief in breathing to make further arrangements. I said: Stopping asthma is not difficult, but since the pulse and complexion are gone, even if the asthma stops, he will still die from deficiency collapse. Thus, in the morning, I used Ginseng Radix et Rhizoma (Renshen), Angelicae Sinensis Radix (Danggui), and Paeoniae Radix Alba (Baishao); in the evening, Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill). After three days, he could lie down, and his appetite doubled. The family was overjoyed, thinking he would survive. I said: When exit and entry cease, the Spirit mechanism perishes; when ascent and descent stop, the Qi establishment becomes precarious. Now, exit, entry, ascent, and descent have all ceased. Even if recovery is attempted, what can be done? This merely temporarily connects the faint breath remaining in the Gate of Life (Mingmen). He will certainly die within ten days; nothing can be done. Later, it proved true. If, before the disease appeared or after it manifested, physicians had used large doses of filling and severe tonifying medicines, although complete cure might not be achieved, life could have been extended somewhat, avoiding such sudden demise. This serves as a warning against unscrupulous physicians recklessly using attacking methods.
In the case of Xu Yanwei’s son, the date of death was predicted one year later; in this case, the critical illness was determined one month in advance. This is because his six pulses were wiry, tight, rhythmic-less, and active. The difference in the timing of death lies in the degree of activity in the pulses. Comparing these two cases reveals the divine accuracy of Siming’s (Gao Gufeng’s courtesy name) palpation.
Xu Yanwei’s son, just four years old, had summer fever, incessant convulsions, curved waist and straight eyes, short red urine, and a dull facial expression. Physicians treated it as Cold Damage (Shanghan) without effect. Invited to examine, I said: Fire dryness generates Wind; Wind disorders affect the extremities. This is not Cold Damage. I used Zi Shui Qing Gan Yin (Nourish Water and Clear Liver Decoction). After one dose, sweating occurred, bowels moved, and fever subsided. I said: Malaria will arrive. The next day, it indeed did. Immediately, Wu Wei Yi Gong San (Five-Ingredient Powder to Benefit the Spleen) was used, adding Ophiopogonis Radix (Maibudong) and Schisandrae Fructus (Wuweizi). After more than ten doses, he recovered. Every time verifying pediatric convulsion syndromes, postpartum tetany syndromes, and stroke-like syndromes, they all belong to Fire dryness generating Wind. Among Cold Damage syndromes, many involve Fire dryness generating Wind. Generally, Wind arises after Fire dryness; Wind comes from within, not from outside, hence called "Wind disorder affecting extremities." If physicians do not know that Wind originates from Fire, and indiscriminately use Qiang Huo, Fang Feng, Xin Yi (Magnolia Flower), and Bai Zhi (Angelicae Dahuricae Radix) which劫 (rob) Wind and dry Blood, then Fire becomes fiercer with Wind, and Yin is destroyed by dryness. Looking at the listed symptoms in the case: first fever, then convulsions, it shows that without Heat, Wind does not generate; without Wind, convulsions do not occur. However, the cause of fever is ultimately Liver-Kidney Yin deficiency. Curved waist indicates Kidney Water deficiency; straight eyes indicate Liver Blood dryness. Moreover, Kidney combines with Bladder, and Liver governs dispersion and excretion. There is no case where Liver-Kidney Yin deficiency exists while urine remains clear and profuse. Although symptoms arise like bees, they are actually linked; the superficial aspects differ, but the root is one. Such is the similarity. Students must know the precision in symptom differentiation to understand the unwavering nature of prescription. Merely using formulas to soothe Liver and tonify Kidney, or Nourish Kidney and Generate Liver, is not incorrect, but there is still a membrane of separation. Careful analysis will reveal this.
Dong Jingfeng from Biling resided on Lake West. A servant suffered from a Heat syndrome with whole-body high fever, irritability, and thirst. Physicians treated it as Cold Damage. I said: Dispersal and cold-natured herbs forced external Heat, turning the interior into severe deficiency Cold. Urgently use Bu Zhong Yi Qi Tang with Pao Jiang (Prepared Ginger). After one dose, sweating occurred, fever removed; after two doses, diet advanced; after three doses, peace returned. Internal True Cold with External False Heat is the principle revealed by Changzhou (Wang Bing) in *Neijing Weizhi*. However, such syndromes are easiest to distinguish yet hardest to identify. Listed symptoms of whole-body high fever, irritability, and thirst appear as Fire syndromes; how to quickly know the interior belongs to deficiency Cold? Because if it were an exterior contraction, there would be no case where, after dispersal, whole-body high fever persists; if it were interior Excess Heat, there would be no case where, after taking cold-natured herbs, irritability and thirst persist. Only because the syndrome seems externally vigorous but actually stems from internal injury, so dispersal destroys Yin; although externally seeming Excess Heat, internally belonging to deficiency Cold, so cold-natured herbs extinguish Fire. Thus, it is Yin excess inside forcing Yang outside. Anyone with understanding can deduce this, let alone those deeply studying the essence of *Neijing*.
Wu Zhangcheng’s younger brother, eight years old, had fever with mental confusion and constipation. Physicians treated it as exterior contraction. I said: This resulted from food stagnation. Due to excessive dispersal, it became deficiency Heat, compounded by Wind herbs drying Blood, causing constipation. First, Liu Wei Yin (Six-Ingredient Decoction) with 3 qian of Rong Rong (Cistanche) was given. He passed over ten dark stools. Subsequently, Bu Zhong Yi Qi Tang was used. After several doses, all diseases were eliminated. Food stagnation blocks Qi, preventing Spleen transportation. At this time, if Liu Jun Zi Tang or similar tonifying agents were used, with minor additions of Zhi Ke (Aurantii Fructus) and Jie Geng (Platycodonis Radix) to assist Spleen in digesting food, Qi would flow, Spleen would transport, and fever/constipation would be prevented. The treating physician mistakenly identified it as exterior contraction and recklessly added dispersal, causing Yin deficiency and Blood dryness, leading to dry intestines and stomach. The ingested food became increasingly retained. If met by a crude physician again, I know they would either double the dose of Xiao Shi (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma), or heavily use Zhi Shi (Aurantii Fructus Immaturus) and Hou Po (Magnoliae Officinalis Cortex). How could they use Kidney-nourishing and Intestine-moistening agents to moisten Yin Blood and allow dry stools to fall naturally? Henceforth, those who only seek one bowel movement to demonstrate their skill should replace Xiao Shi, Da Huang, Zhi Shi, and Hou Po with Shu Di Huang (Rehmanniae Radix Preparata) and Rong Rong. Fortunately, do not accept the title of "Stool Physician" praised by Dongzhuang.
A country laborer worked hard in fields, was very hungry, ate suddenly until full, lay tired for half a day, and upon waking, suddenly lost voice and could not speak. This lasted over twenty days. He sought my diagnosis. I said: Fatigue injures Spleen; hunger and fullness injure Stomach. Mingyang Qi is obstructed and cannot ascend; body fluids do not circulate; the cardia is blocked and stiff, hence speech cannot emerge. I gave him ten large doses of Bu Zhong Yi Qi Tang. While sleeping at noon, he sweated all over, and speech returned to normal. Using Bu Zhong Yi Qi Tang to treat aphasia without addressing the throat and tongue surprised everyone as unusual. Who knew it was quite ordinary? It simply pierces the source of the disease. But what disease does not have a source? Why do treating physicians remain ignorant and fail to search for it?
A countryman suffered from a carbuncle on the back, extending from Fengfu (GV16) to Shenshu (BL23). The entire area swelled, muscles were blue and cold, hard as iron, appetite ceased, and consciousness was lost. Physicians still used detoxifying herbs. I diagnosed: all six positions showed fine and rapid pulses; Qi and Blood were severely depleted; toxin was about to sink inward. Urgently use Yang Rong Tang (Nourish Glory Decoction) with Fu Zi (Aconiti Lateralis Radix Preparata) and Pao Jiang. After three large doses, Stomach Qi opened; after ten doses, hardness dispersed by 80-90%, leaving only the left side tea-cup sized, red and painful. I warned: Do not use binding pastes or needles/lancets. With mild Qi and Blood, toxin will discharge itself. Binding delays it; puncturing out of season makes closing difficult. Unable to bear pain, he underwent puncturing and bleeding. I said: Double the previous medicine and take urgently until wounds close. Still warn to restrain desires and guard diet, concurrently服用 Huan Shao Dan and Ba Wei Wan. He recovered. Syndromes have internal and external aspects; principles have no separation. Those who specialize in external syndromes but do not understand internal ones surely do not understand external ones either. Thus, if this case fell to crude surgical skills, only toxic herbs to reduce swelling and Qi-breaking herbs to open appetite would be used. How could they consider the deficiency of the root or the sinking of the toxin? Siming’s comprehensive response to internal and external aspects was always appropriate. This was due to clear differentiation of pulse and symptoms, and thorough integration of internal and external unity.
Cao Yuansi’s wife had missed menstruation for four months, continuous abdominal pain, and reduced appetite. Physicians treated it as Fetal Fire. I said: This is stagnant Blood. However, her constitution is weak; tonification with movement is needed. Use Ba Zhen Tang (Eight-Treasure Decoction) for three large doses. Indeed, over a sheng of blood clots were discharged, but abdominal pain remained. Large doses of Yang Rong and other tonics regulated her, pain ceased, appetite improved. In the ninth case, fresh blood gushed, and draining stasis-promoting drugs were used; in this case, stagnant blood was treated with blood-tonifying agents to promote movement. Sometimes attacking what others dare not attack, sometimes tonifying what others dare not tonify. Truly requires courage, and especially insight that others lack.
Jiang Zhonglian from Huizhou, exposed to cold with fever, had swollen jaws the size of a sheng, countless lumps on arms, no eating or bowel movement, mania, restlessness, and thirst. Pulse was floating, rapid, and disordered. Physicians treated it as Cold Damage with toxin eruption. I said: Incorrect. This is Dryness driving Wind generation. Use large doses of Shu Gan Yi Shen Tang (Soothe Liver and Benefit Kidney Decoction), adding up to 2 liang of Shu Di Huang. After five doses, swelling subsided, bowels moved; after ten doses, fever removed, appetite returned. Then Bu Zhong Yi Qi Tang with Mai Dong (Ophiopogonis Radix) and Wu Wei Zi was used for regulation and recovery. Exposed to cold with fever means Fire was constrained by Cold pathogen. Long constraint causes Blood to be forced by Fire, transforming into Dryness syndrome. However, for the same Dryness syndrome, in Xu Yanwei’s son, Clearing Liver was used because of short red urine. Red is the natural color of Hand Shaoyin (Heart), appearing in urine indicates Heart Fire hyperactivity reaching Bladder. Thus, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) was used to nourish Kidney, adding Chai Hu (Bupleuri Radix), Zhi Zi (Gardeniae Fructus), Dang Gui (Angelicae Sinensis Radix), and Bai Shao (Paeoniae Radix Alba) to clear Liver. Nourishing Kidney nourishes what controls Fire; clearing Liver clears the source of Fire. Especially wonderful are Zhi Zi and Suan Zao Ren (Ziziphi Spinosae Semen). Since Heart Fire forces downward into Bladder, without Zhi Zi’s twisting downward path, how to guide its momentum to drain Heart channel Dryness Fire? Moreover, since Yang Fire in the channel is hyperactive, Yin Qi must be deficient. Without Suan Zao Ren, how to make Yin from Dang Gui and Shu Di Huang gather and enter Pericardium to nourish Heart channel Yin Qi? Each formula has its purpose; usage must be appropriate. Knowing the subtlety of Nourishing Kidney and Clearing Liver in that case reveals the subtlety of Soothing Liver and Benefiting Kidney in this case.
Xu Daqian’s granddaughter, over ten years old, had fever for several days, neck stiffness and pain, difficulty with urination and defecation. Suddenly at midnight, she experienced reversal coldness, eyes rolling up, asthma, locked jaw, and clenched teeth. I diagnosed: Disease transmitted from Taiyang to Yangming, now to Shaoyang. Jia and Yi are siblings, thus transmitting to Jueyin. Told family: Fortunately, being young, it is curable. Urgently use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction). Finished three doses overnight, and she revived. By fifth watch, she could speak. Next, Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Xie Xin Tang (Drain the Epigastrium Decoction) etc. were used for regulation and recovery. Any transmission from Yang channels to Yin channels is not treated as Yin syndrome but still treated from Yang channels. Siming’s approach to feeling pathogens involves identifying channels based on symptoms and prescribing according to channels. Thus, Zhang Zhongjing truly never dies.
Shen Mengjia’s wife from Hangzhou suffered from acid regurgitation and diaphragmatic pain for years, emaciated, nearly starving. I diagnosed: All six pulses fine and rapid. This is Liver Wood overcoming Spleen Earth. First, Liu Jun Zi Tang (Six-Gentleman Decoction) with Pao Jiang was administered. After ten-plus doses, acid regurgitation halved. Then, Bu Zhong Yi Qi Tang with Ban Xia (Pinelliae Rhizoma) and Pao Jiang was used. After ten-plus doses, acid regurgitation disappeared, diaphragmatic pain resolved. Next, Gui Pi Tang (Restore the Spleen Decoction) with doubled Mu Xiang (Aucklandiae Radix) and Pao Jiang, swallowing Ba Wei Wan, led to recovery. Wood is described as bending and straightening; bending and straightening produces sourness. Thus, all sourness syndromes belong to Liver Wood, as sourness is the Qi of Wood. However, in others, this syndrome would be mixed into Xiao Yao San (Free and Easy Wanderer Powder), Zuo Jin Wan (Left Metal Pill), Liver-soothing, and Kidney-nourishing treatments. Siming, however, saw Liver Wood overcoming Spleen from the fine and rapid pulses, using Liu Jun Zi and Bu Zhong Yi Qi to cultivate Spleen Earth, adding pungent Pao Jiang to control Liver Wood’s sourness. Then using Gui Pi and Ba Wei to tonify Fire and generate Earth to conclude treatment. Ask current practitioners: who can be so clear and accurate?
Lu Zhongjia’s wife, at fourteen years old unmarried, suffered from alternating chills and fever. After marrying Zhongjia, for over ten years, chills and fever remained. Treated as malaria or deficiency, she became emaciated, nearly skeletal. Invited me to diagnose. I said: This is neither malaria nor deficiency, but Blood-Wind syndrome. Use Wu Jia Pi San (Tribulus Powder) with 2 liang of Shu Di Huang. Each dose totaling 5-6 liang of herbs, boiled in 2 sheng water to 1 sheng, taken entirely daily. After twenty doses, chills and fever instantly ceased. This case’s treatment originated from *Zhun Sheng* (Standard Guidelines). However, such symptom differentiation requires unique insight.
Wu Weishi’s son, just ten years old, had fever, thirst, chest and abdominal stuffiness and pain. I said: Shaoyang-Yangming syndrome. Used Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). That night, he felt dizzy for over one to two hours. Weishi was terrified. I said: No harm. But this disease will not transmit to malaria; it must transmit to dysentery. After three days, fever subsided, indeed lower abdominal pain occurred, passing numerous dark stools first, followed by pus and blood in stool (dysentery). Continued using Dang Gui Jie Du Tang (Angelica Detoxification Decoction) for five to six doses, dysentery cleared. Then Liu Jun Zi Tang for regulation and peace. Chest pain and fever are Shaoyang symptoms; thirst and abdominal stuffiness are Yangming symptoms. Malaria with chills and fever is Shaoyang; dysentery with pus and blood is Yangming. Yet symptoms had not yet appeared; how did Siming know? Because the syndrome belongs to concurrent involvement of two channels, it is known that pathogen gathers in Shaoyang, thus transmitting to malaria; toxin returns to Yangming, thus transmitting to dysentery. The reason it did not transmit to malaria but to dysentery is that Xiao Chai Hu Tang is the specific agent for Shaoyang. After taking it, dizziness occurred, meaning Shaoyang pathogen was already dispersed through sweating, specifically because Zheng Qi could not overcome Pathogen completely, thus failing to expel it entirely. However, even if incomplete, after exceeding three days, it has entered the Fu organs and has nothing to do with Shaoyang anymore. Why mention transmitting to malaria? Thus, knowing future progression, predecessors only base judgments on current primary disease, following channels and principles, not guessing randomly hoping for coincidence. Students, if you seriously study these areas, understanding one helps understand another; over time, you may also excel. Who says ancients and moderns cannot catch up?
Fan Zhongxing returned from self-reflection to Shimen, caught Wind-Cold, and engaged in excessive sexual activity. Fever and mental confusion ensued. Physicians thought it was Cold Damage, used Qiang Huo and Chai Hu, ineffective. Thought it was Yin syndrome, used Rou Gui (Cinnamomi Cortex) and Mu Xiang (Aucklandiae Radix), ineffective. Fever worsened, appetite ceased, tongue black as charcoal, no bowel movement for eight days. Physicians planned purgation. I visited, diagnosed fine, rapid, deep pulses. Told them: Yin deficiency is severe, Stomach Qi is about to perish. Only mild, warm, sweet, and moistening agents can save him. Urgently use Zuo Gui Wan (Left Restoring Pill) and Zi Shui Qing Gan Yin, heavily adding Ren Shen (Ginseng) and Huang Qi (Astragali Radix). Other physicians asked: How to discuss tonification for constipation? I said: Do you think it is Cheng Qi syndrome? Mistaken. Just take medicine, bowel movement will come naturally. On the fourth day, indeed passed over a sheng of dark stools, fever subsided, tongue turned red and moist. But still not eating; family still suspected tonification. I comforted: Originally internal injury syndrome, Bu Zhong Yi Qi Tang alone suffices. Unfortunately, crude doctors mixed treatments, damaging Stomach Qi further, preventing immediate recovery. Now tonify with medicine, regulate with thin porridge. In a few days, taste will return naturally, do not worry. Family did not believe, hired another doctor, heavily used Cheng Qi Tang. After two doses, no bowel movement, condition worsened. Ashamed to ask me again. Went to Hezhong to invite Xue Chuyu. Chuyu arrived, family narrated condition and medication sequence. Chuyu said: Since Shu Di Huang produced bowel movement, efficacy is known. Why abandon success at the threshold? Now powerless. Days later, he indeed died. Family accused Chuyu of being my faction, but ultimately did not believe. Alas! Calling all learned people in the world factions, for their physicians, is it not difficult?
Such syndromes fail once due to chaotic medical intervention, and again due to indecisive judgment. Thus abandoning near-successful results is truly regrettable. However, since the patient contracted illness due to labor and violated sexual restraint excessively, he essentially walked into his own death. Post this as a warning for those who轻视 life and lust.
Old friend Xu Wuyi’s nephew, Ci Mou, suffered from cough. I finely diagnosed his pulse; all six positions were active, secretly suspicious. Asked: Do you love alcohol? Yes. Asked: Do you perhaps take Tian Men Dong, Mai Men Dong, Shu Di Huang, Zhi Mu, Bei Mu etc.? Took over a jin. I said: Your disease opposes these herbs; stop taking them immediately. Prescribed Gui Pi Tang and Liu Wei Wan. Returning home, I told Yonghui: Ci Mou’s disease is what *Suwen* calls "Diseases of Er Yang originating from Heart and Spleen." The person must have overworked mind, loved alcohol, and had excessive desires. Urgently saving Three Yin is the good method. Physicians forced Yin Cold, Fire had no outlet for anger, becoming prairie fire. Now six pulses are purely Yin Fire, exiting without entering, dying within a year. Guests present were shocked: Ci Mou is fine, only caught a cold, why so dire? I said: Pulse method dictates this. In August, I stayed with Yonghui at Gushan. Ci Mou invited me to Tianzhu, said: Heard you are skilled in Taisu, please diagnose for me. Can I pass exams in Xin Chou year? I said: Taisu comes from San Fen, stolen by later generations to deceive the world, creating rhymes predicting fortune/misfortune. Xuanyuan and Qibo had none of this. But *Suwen* has its own sayings on prosperity/withering, longevity/shortness, wealth/poverty, gain/loss, success/failure, essentially not departing from Sage’s principles of auspicious/inauspicious, regret/regretless, good/evil, contrary/conforming. The way is subtle. But I can roughly explain. After diagnosis, I told him: Xin Chou is good, but Jia Chen is more appropriate. Ci Mou asked about longevity. I said: You are just over thirty, no need to ask about longevity. Observing his intent, he prioritized imperial examinations over health, difficult to state directly. His father, Daqian Gong, a loyal and thick-hearted elder, visited me warmly, hurriedly returned to Shimen to tell: Son’s pulse Qi is poor; if he goes north, will he return? Why don’t you stop him? Said: