予固阻之弗能也。因为制大料参膏。语大千曰。公当戒令郎不绝服之。庶可冀其还家。如惑以火
不清不宜补。殆矣。到京。果闽人有以前说进者。次 信之。用发散寒凉。不十剂吐血而绝。
木必有根。水必有源。而病亦必有本。本者所以致病之根源也。长洲医案二十四种。卷帙甚
繁。然一言以蔽之。只是治病必求其本耳。案中劳心过度嗜酒多欲八字。乃病者所以致病之本也
。医家早以归脾六味直从本治。宁遽至是。何不知出此。而以阴寒逼之。已滨于死。而又用发散
寒凉等剂。遂使三阴立尽耶。可慨已。
业师徐先生号五宜。壬寅秋。患滞下脓血。昼夜百余次。里急后重。医诊之曰。脉已歇至矣
。急用浓朴青皮槟榔枳壳木香等。或可挽回。业师与鼓峰最契。习闻理解。颇疑之。不肯服。时
鼓峰归四明。予往候。曰。尔试为我诊之。脉洪弦而数。或一二至。或三四至。或五六至辄一止
。予曰。毒及少阴矣。当急顾其阳明。方用生熟地黄各一两。归芍丹皮黄连各三钱。甘草五分。
群医议予方云。痢疾一症。虽古名医所用药。不过数味耳。今尽反常法。恐无当于病。服之必饱
闷增剧矣。次日往候。次数尚频。而急重已除。诊其脉。洪数亦减。至数相续。是日复用前方。
病去大半。又次日。去生地黄连。加人参白术山药茯苓等药。饮食大进。午后师自按脉。曰。尔
前谓吾脉尚弦。此刻渐减矣。诊之果然。而至数复有止状。或骇曰。病退而脉复变。得无恙乎。
予曰。无妨也。歇至者。即古代结促之俗名也。若冲气中绝。脏脉自见者危。今吾师歇至。本以
毒盛拥遏坠道。阴精不承。故一二至。或三四至。或五六至而止也。经曰。数动一代者。病在阳
之脉也。泄及便脓血。今予去
阴药过甚。进阳药太骤。中脏得和。则木土和而胃气安。故饮食进。而毒尚未尽者。亦随壮气而
旺。故复有止状也。于方中仍加生地黄连即平矣。如言而安。
痢疾一症。惟王损庵论独得其奥。而法亦极其详。故善治痢者。未有不以准绳为准绳者也。
是案议论症治与辨晰脉义处。尤足补准绳之所未及。学人其并入准绳痢疾条下参看可也。
姚江姻友陈紫绮内人。半产。胎衣不下。连服行血催衣之药四剂。点血不行。胸痛瞀乱。予
往视曰。此脾失职也。先与黄 一两。当归一两。下咽而瞀乱顿减。时有以准绳女科中恶阻血不
下及胞衣不下方书一本进者。上注某方经验某方试效。紫绮以示予曰。中有可用否。曰。一无可取
。遂用大剂人参白术芍药黄 当归茯苓甘草等药。一服而恶露渐至。皆惊叹曰。古方数十。一无
可用。而独以是奏功。准绳一书。真可废也。予曰。恶。是何言。王损庵医之海岱也。顾读书者
自不察耳。若唯以恶阻及胞衣不下条中。求合吾方。宜其谬也。试以血崩及血下不止条中求之。
吾方可见矣。盖此病本气血大亏而至半产。脾失统血之职。水湮士崩。冲决将至。故生瞀乱。不
为之修筑。而反加穿凿。是虚虚也。吾正忧血下之不止。而彼且忧血之不下。其不合也。又何怪
焉。曰。今从子法。可遂得免乎。曰。不能也。穿凿过当。所决之水。已离故道。狂烂壅积。势
无所归。故必崩。急服吾药。第可固其堤岸。使不致荡没耳。至第三日。诊尺内动甚。予曰。今
夜子以前必
崩矣。去予家尚远。因留方戒之曰。血至即服。至黄昏果发。如予言。得无恙。方即补中益气汤
加参 各二两也。次用调补脾肾之药而愈。
凡半产总属气血两亏所致。可知半产后之胎衣不下。亦是气虚不能推送。血虚不能润利之故。
行血催衣等剂。亟当禁忌。乃每见女科庸技临此等症。非查肉桃仁。即红花香附。祖授师传。只
此数味。而不知其入人肠胃。利如锯斧也。特示此案以救之。 倩钟静远。暑伤元气。便血。胸
膈满闷。数至圊而不能便。医用半夏浓朴苍术枳实山楂青皮槟榔延胡索杏仁花粉诸破气祛痰药。
便益难。胸益闷。迁延半月许。予往视。舌起黑胎。发热。胸膈痛甚。脉浮数。曰。此药伤真阴
。火无所畏。故焦燥也。且问医治法云何。日。三次下之矣。邪甚不能解。今当再下之耳。予曰
。脉数奈何。则唯唯无所应。予乃重用生熟地黄。以丹皮归芍佐之。饮药未半瓯。即寒栗发战。
通体振掉。自胸以上汗如雨。举家惊疑。迎医视之。则不知其为战也。妄骇谓吾固知补药不可服
。今果然。急浓煎陈皮汤及生莱菔捣汁饮之。云唯此可解地黄毒也。继进凉膈散。倍硝与大黄。
下清秽数升。复禁绝饮食。粒米不许入口。舌转黑。胸转闷。群医又杂进 痰丸大小陷胸汤
等剂。剧甚垂危。复邀予诊之。脉数极而无伦。痰拥胁痛。气血不属。症已败矣。非重剂参术。
不能救也。先以新谷煮浓粥与之。胸膈得宽。乃稍稍信予。试进参
术等味。得汗。下黑矢。神气顿安。而痰嗽不止。所咯皆鲜血。向有痔疾。亦大发。痛不可忍。
脾下泄。其家复疑参术助火。予曰。此参术之力不及。不能助火生士耳。遂投人参二两。附子六
钱。炮姜吴茱萸肉桂补骨脂 术归芍。药称足。一服而咯血即止。痔痛若失。但恐悸不能寐。吸
气自鼻入口。觉冷如冰雪。虽热饮百沸。下咽即寒痛欲利。乃制一当茶饮子。用人参二两。熟地
黄二两。炮姜三钱。制附子六钱。浓煎频饮。入口便得卧。每日兼用参附养荣汤。元气渐复。时
鼓峰至邑。同邀过看。鼓峰问静远曰。曾举几子矣。静远骇曰。吾病岂终不起耶。何遽问此。鼓
峰曰。非也。脏腑多用硝黄攻过。尽变虚寒。生生之源。为药所伤。今病虽愈。不服温补。恐艰
于生育耳。故予每与用晦言。医当医人。不当医病也。静远乃震悟曰。非二公。几杀我。任医如
任将。皆安危之所系也。然非知之深者。不能信之笃。非信之笃者。不能任之专。故惟熟察于平
时。而有以识其蕴蓄。乃能倾信于临事。而得以尽其所长。使必待渴而穿井。斗而铸兵。则仓卒
之间。何所趋赖。一旦有急。不得已而付之庸劣之手。最非计之得者。观病家与东庄谊。关至戚
。乃信任不专。而几为庸医所杀。可鉴也。倘有阅是案而留意于未然者。又孰非不治已病治未病。
不治已乱治未乱之明哲乎。 此症已滨于死。而东庄复置之生。非如此破格挽回。岂能出奇奏效
耶。观其所制当茶饮子。具见良工心苦矣。 医当医人。不当医病一语。深合内经治病求本之旨。
从长洲医案中细体之自见。
姚江钱 都子。五岁。病疹。泄泻。儿医谓 毒最宜于泻。不复顾忌。以清火为急。寒凉纵进。病
势殊剧。来邀予视。面色两颧嫩红。时切牙喘急。口渴甚。饮水不绝。脉洪缓如平壮人。予曰。
脾急矣。速投人参白术当归黄 陈皮甘草茯苓木香以救之。一剂觉安。次日有邻族人来候。惊阻之
曰。误矣。小儿有专门。岂可令腐儒治之。吾所闻 病。以发散清凉解毒为主。今半身 潮未退
。而用温补。必不救矣。其家惧。遂不敢再服。间二日。 都复来见予。曰。诸症复如故。如何
。予曰。岂有是理哉。君戏我耳。曰。日来实不服尊剂。乃述其故。予曰。君试急归。令郎天柱
倒矣。别去。顷之驰至。曰。果如公言。奈何。急服前方何如。予曰。前方救虚也。今加寒矣。
非桂附不能挽也。曰。颧红喘急口渴饮水。俱是热症。而公独言虚寒。何也。曰。阴竭于内。阳散
于外。而寒凉复逼之。阳无所归。内真寒而外假热。此立斋先生所发内经微旨。非深究精蕴者。
不能信也。 都归。违众服之。一剂而天柱直。二剂而喘渴止。三剂起行。嬉戏户外。
观此案。则知小儿 症。亦尚有阳亏者。谁谓稚幼纯阳。必无补阳之法耶。
吴华崖先生馆僮。夏月随彼湖上。归感热症。下利脓血。身如燔炙。予过视之曰。此阳明病
也。不当作痢治。视其舌必黑而燥。夜必多谵语。其父母曰。诚如所言。请诊之。则脉已散乱。忽
有忽无。状类虾游。不可治也。华崖强予治之云。固知无生理。亦冀其万一。不得已用熟地黄一
两。生地麦冬当归白芍药甘草枸杞子
佐之。戒其家曰。汗至乃活。次日复往。曰。昨夜热不减。而谵语益狂悖。但血痢不下耳。服药
后见微汗。少顷即止。殆不可治。予曰。无惊。且诊之。则脉已接续分明。洪数鼓指。予喜曰。
今生矣。仍用前方去生地黄加枣仁山药山茱萸牡丹皮。连服六帖。其家以谵妄昏热不减。每日求
更定方。予执不可。姑再忍。定以活人还汝。是日诊其脉。始敛而圆。乃曰。今当为汝去之。用
四顺清凉饮子。加熟地黄一两。大黄五钱。下黑矢数十块。诸症顿愈。越二日薄暮。忽复狂谵发
热。喘急口渴。举家惶惑。谓今必死矣。予笑曰。除是服庸医药。不然。虽挺刃击之。不死也。
岂忌吾言乎。得汗即活矣。遂投白术一两。黄 一两。干姜三钱。甘草一钱。当归芍药各三钱。
尽剂。汗如注。酣卧至晓。病霍然已。或曰。阳明热甚。当速解其毒。在古人亦必急下之以存真
阴之气。今子先补而后下。其义何居。予曰。毒火燔炽。凉膈承气症也。而其源起于劳倦。阳邪
内灼。脉已无阴。若骤下之。则毒留而阴绝。死不治矣。不闻许学士治伤寒乎。发热头痛烦渴。
脉浮数。曰此麻黄证也。然荣气不足。未可发汗。先以黄 建中汤饮之。其家煎迫发汗语至不逊。
许但忍之。至五日。尺部脉应。方投麻黄而愈。因谓医者须顾表里虚实。待其时日。若不得次第
。临时虽安。损亏五脏。以促寿限。何足贵哉。南史载范云病伤寒。恐不预武帝九锡之贺。责良
医徐文伯以速效。文伯曰。此诚不难。但二年后不复起耳。云强之。文伯烧地布桃叶以法汗之。
翌日果愈。云甚喜。文伯曰。不足喜也。后二年果卒。夫取汗先期。尚促寿限。
况可罔顾脏腑脉症而妄下乎。或曰。此则闻教矣。间日复病。而子又以他药愈之。何也。曰。病
从阳入。必从阳解。今阴气已至。而无以鼓动之。则荣卫不洽。汗无从生。不汗。则虚邪不得外
达。故内沸而复也。先补后下与先补后汗。皆虚回后清邪意也。至于病从阳入必从阳解之义。则
更发前人所未发。非精察内经深蕴者。未许窥其妙义。
亡友孙子度侄女。适张氏。病半产。咳嗽吐血。脉数而涩。色白。胃满脾泄。医用理气降火
止血药。益甚。予投理中汤。加木香当归倍用参术而血止。继用归脾汤。及加减八味饮子。诸症
渐愈。时鼓峰从湖上来。邀视之。鼓峰曰。大虚症得平至此。非参术之力不能。今尚有微嗽。夜
热时作。急宜温补以防将来。因定朝进加减八味丸。晡进加减归脾汤。未几过粗工语之。诧曰。
血病从火发。岂可用热药。遂更进清肺凉血之剂。病者觉胃脘愈烦惋。饮食不进。而迫于外论。
强服之。逾月病大发。血至如涌。或紫或黑或鲜红。病者怨恨。复来招予往视之。曰。败矣。脏
腑为寒凉所逼。荣卫既伤。水火俱竭。脉有出而无入。病有进而无退。事不可为也。未几果殁
。仁斋直指云。荣气虚散。血乃错行。所谓阳虚阴必走也。曹氏必用方云。若服生地黄藕汁竹茹
等药。去生便远。故古人误解滋阴二字。便能杀人。况粗工并不识此。随手撮药。漫以清火为辞
。不知此何火也。而可清乎。所用药味。视之若甚平稳。讵知其入人肠胃。利如斧锯。如此可畏
哉。夫血脱益气。犹是
粗浅之理。此尚不知。而欲明夫气从何生血从何化。不亦难乎。操刀必割。百无一生。有仁人之
心者。愿于此姑少留意也欤。
病家之要。全在择医。然而择医非难也。而难于任医。任医非难也。而难于临事不惑。确有
主持。而不致朱紫混淆者之为更难也。倘不知此。而偏听浮议。广簇医。则骐骥不多得。何非
冀北驽群。帷幄有神筹。几见圯桥杰竖。危急之际。奚堪庸妄之误投。疑似之秋。岂可纷纭之错
乱。一着之谬。此生付之矣。以故议多者无成。医多者必败。从来如是也。如此症若信任专而庸
技不得以间之。亦何至举将收之功而弃之哉。每一经目。殊深扼腕。徐鸾和内。病咳嗽。医以伤
风治之。益甚。邀予诊。则中虚脉也。曰。鼻塞垂涕痰急。皆伤风实症。何得云虚。予曰。此处
真假。所辨在脉。庸医昧此。枉杀者如麻矣。彼不知脉。请即以症辨之。其人必晡时潮热嗽甚。
至夜半渐清。至晨稍安。然乎。曰然。然则中虚何疑乎。所可喜者。正此鼻塞垂涕耳。乃投人参
白术当归黄 白芍药各三钱。软柴胡升麻各一钱。陈皮甘草五味子各六分。三剂而咳嗽立愈。
再往诊。谓之曰。上症已去。唯带下殊甚。近崩中耳。鸾应曰然。即前方重用人参加补骨脂阿胶
各二钱数剂。兼服六味丸而愈。
南湖沈松如。举此案问予云。于鼻塞垂涕中。诊得中虚。人或能之。于咳嗽既愈后。看出带
下。东庄果何
所见耶。予曰。东庄亦只是于中虚脉症中。讨出消息耳。盖中气者。金赖以生。而水借以摄者也
I firmly dissuaded him, but he would not listen. Therefore, I prepared a large dose of Ginseng Paste (Renshen Gao). I said to Daqian: "You must instruct your son to take it continuously; perhaps we can hope for his recovery and return home. If you are confused by the notion that 'fire pathogen is not cleared and tonification is inappropriate,' it will be disastrous." Upon arriving in Beijing, indeed, a person from Fujian advanced the previous theory. Ci (a person's name) believed it and used diaphoretic and cold-natured formulas. Within ten doses, the patient vomited blood and died.
Trees must have roots, water must have sources, and diseases must have origins. The "origin" refers to the root cause of the disease. The Twenty-Four Cases of Changzhou are voluminous, but in one word, they emphasize only that treating disease requires seeking its origin. The eight characters mentioned in the cases—"overwork of the mind, alcoholism, and excessive desire"—are precisely the root causes of the patient's illness. Physicians should have treated directly from the origin using Guipi Tang (Restore the Spleen Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), so how could it reach this state? Why did they not consider this, but instead forced Yin-cold upon him, bringing him to the brink of death, and then used diaphoretic and cold-natured agents, causing the Qi of the Three Yin channels to deplete instantly? It is truly lamentable.
My teacher, Mr. Xu, courtesy name Wuyi, suffered from dysentery with pus and blood in autumn of the Renyin year, defecating over a hundred times day and night, with tenesmus. The physician diagnosed: "The pulse has reached a state of intermittent stopping (Xiezhi); it is urgent. Use thick bark of Magnolia officinalis (N Hou), green tangerine peel (Qing Pi), areca nut (Bing Lang), bittersweet orange fruit (Zhi Ke), and costus root (Mu Xiang); perhaps it can be salvaged." My teacher was closest to Gufeng and had often heard Gufeng explain medical principles, so he suspected this diagnosis and refused to take the medicine. At that time, Gufeng returned to Siming, and I went to visit him, saying, "Please try to diagnose my pulse." The pulse was surging, wiry, and rapid, sometimes stopping after one or two beats, sometimes after three or four, sometimes after five or six. I said, "The toxin has entered the Shaoyin channel. We must urgently protect the Yangming channel." The prescription consisted of Raw Rehmannia Root (Sheng Dihuang) and Prepared Rehmannia Root (Shu Dihuang), each 1 liang; Angelica sinensis (Danggui), White Peony Root (Baishao), Moutan Cortex (Danpi), and Coptis Rhizome (Huanglian), each 3 qian; Licorice Root (Gancao), 5 fen. The other physicians discussed my prescription, saying, "For dysentery, even ancient famous doctors use only a few herbs. Now you completely reverse the conventional method; it is likely unsuitable for the disease. Taking it will surely increase fullness and oppression." The next day, I visited again. The frequency of defecation remained high, but the tenesmus had been eliminated. Diagnosing the pulse, the surging and rapid quality had decreased, and the rhythm was continuous. On that day, I used the same prescription again, and the disease diminished by more than half. The following day, I removed Raw Rehmannia Root and Coptis Rhizome, adding Codonopsis Pilosula (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), Dioscorea Opposita Tuber (Shanyao), and Poria (Fuling). His appetite greatly improved. In the afternoon, my teacher palpated his own pulse and said, "You previously said my pulse was still wiry; now it is gradually weakening." The diagnosis confirmed this, yet the pulse rhythm showed signs of stopping again. Someone was alarmed and said, "The disease receded, but the pulse changed; is there no danger?" I said, "No harm. Intermittent stopping (Xiezhi) is the common name for Jie and Cu pulses in ancient times. If the Chong Qi is interrupted and the Zang pulse appears on its own, it is critical. However, my teacher's intermittent pulse is due to abundant toxin obstructing the intestines, preventing Yin essence from ascending, hence stopping after one or two, three or four, or five or six beats. The Classic says: 'Rapid, moving, and intermittent pulse indicates disease in the Yang.' Here it refers to diarrhea and passage of pus and blood. Now that I have removed overly cloying Yin-nourishing herbs and introduced Yang-tonifying herbs too abruptly, the middle Jiao organs harmonized, Liver Wood and Spleen Earth became harmonious, and Stomach Qi was secured, so food intake increased. The remaining uneliminated toxin, boosted by the strengthening Qi, manifested as intermittent stops. Re-adding Raw Rehmannia Root and Coptis Rhizome to the formula will resolve this." Following this advice, the condition stabilized.
Regarding dysentery, only Wang Sun'an's discussion captures its profound essence, and his methods are extremely detailed. Therefore, those skilled in treating dysentery do not use *Zhunsheng* (Standard Scale) as their standard. The discussions on symptoms and treatment in this case, as well as the analysis of pulse meanings, sufficiently supplement what *Zhunsheng* omitted. Students should refer to it alongside the Dysentery section in *Zhunsheng*.
Ms. Chen Ziqi, wife of my relative and friend from Yaojiang, suffered a miscarriage with retained placenta. After taking four doses of blood-invigorating and placenta-expelling medicines without any bleeding, she experienced chest pain and confusion. I examined her and said, "This is spleen dysfunction." I first prescribed Astragalus Membranaceus Root (Huangqi) 1 liang and Angelica sinensis (Danggui) 1 liang. After swallowing, the confusion immediately subsided. At that time, someone presented a copy of *Zhunsheng: Gynecology*, specifically the sections on nausea/vomiting with blood stagnation and retained placenta, annotated with notes like "this formula is experienced/effective." Ziqi showed it to me and asked, "Is there anything usable here?" I said, "Nothing at all." So I used a large dose of Codonopsis Pilosula (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), White Peony Root (Shaoyao), Astragalus Membranaceus Root (Huangqi), Angelica sinensis (Danggui), Poria (Fuling), and Licorice Root (Gancao). After one dose, lochia gradually appeared. Everyone exclaimed, "Dozens of ancient formulas were useless, yet this single one succeeded. *Zhunsheng* can truly be discarded." I said, "Ah, what words are these! Wang Sun'an is the sea and mountains of medicine; it is merely that readers fail to observe. If one seeks compatibility with my formula only in the sections on nausea/vomiting and retained placenta, it is naturally erroneous. Try looking in the sections on uterine bleeding and continuous blood loss, and the rationale of my formula becomes clear." This illness originated from severe deficiency of Qi and Blood leading to miscarriage, where the Spleen lost its function of controlling blood, like water flooding and earth collapsing, threatening to burst forth, causing confusion. Instead of reinforcing the embankment, we drilled through it, making the deficiency worse. I worried about uncontrollable bleeding, while they worried about lack of bleeding; how could this match? Asked, "If we follow your method, can we avoid disaster?" I replied, "No. The excessive drilling has caused the water to leave its channel, accumulating wildly with no outlet, so collapse is inevitable. Taking my medicine quickly can only reinforce the banks to prevent total inundation." By the third day, the radial pulse at the cun position was very active. I said, "Collapse will occur before midnight tonight." Since my home was far, I left a prescription and warned, "Take it as soon as bleeding starts." At dusk, it indeed started, exactly as predicted, and she remained safe. The formula was Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Codonopsis Pilosula (Renshen) and Astragalus Membranaceus Root (Huangqi), each 2 liang. Subsequently, she recovered with formulas regulating and tonifying the Spleen and Kidney.
Generally, miscarriage is always caused by dual deficiency of Qi and Blood. Thus, retained placenta after miscarriage is due to Qi deficiency failing to push and Blood deficiency failing to lubricate. Formulas that invigorate blood and expel the placenta must be strictly contraindicated. Yet, I often see mediocre gynecologists facing such cases using only Chuanxiong Rhizoma (Chuanxiong), Peach Kernel (Taoren), Red Flower (Honghua), and Cyperus Rhizome (Xiangfu), passed down from master to apprentice, unaware that entering the stomach and intestines, they act like saws and axes. I present this case to save people.
Qian Zhongjingyuan suffered from summerheat damaging Yuan Qi, hematochezia, chest and epigastric fullness, frequent trips to the toilet but inability to defecate. The doctor used Pinellia Tuber (Banxia), Magnolia Bark (N Hou), Atractylodis Rhizoma (Cangzhu), Immature Bitter Orange (Zhishi), Hawthorn Fruit (Shanzha), Green Tangerine Peel (Qingpi), Areca Nut (Binglang), Corydalis Rhizome (Yanhusuo), Apricot Seed (Xingren), and Trichosanthes Root (Huafen)—all Qi-breaking and phlegm-resolving drugs. Bowel difficulty increased, chest oppression worsened, persisting for half a month. I examined him: black coating on the tongue, fever, severe chest pain, floating and rapid pulse. I said, "These drugs damaged True Yin; Fire has no fear, hence scorching and dryness." I asked the doctor's treatment plan. He said, "We have purged three times; the pathogen is severe and unresolved; we must purge again." I asked, "What about the rapid pulse?" He gave no answer. I then heavily used Raw Rehmannia Root (Sheng Dihuang) and Prepared Rehmannia Root (Shu Dihuang), assisted by Moutan Cortex (Danpi), Angelica sinensis (Danggui), and White Peony Root (Baishao). Before drinking half a bowl, he began shivering and trembling, sweating profusely from the chest up. The family was alarmed and called the doctor, who mistook the battle sweat for something else, falsely claiming he knew tonics were inadvisable and now it proved true. He urgently prescribed concentrated Chenpi (Tangerine Peel) decoction and fresh Radish juice, claiming this alone could detoxify Rehmannia. Then Lianpo San (Clear the Chest Powder) was given with doubled Mirabilite (Xiaoshuang) and Rhubarb (Dahuang), evacuating foul matter several liters. Diet was strictly forbidden. The tongue turned black, chest oppression worsened. Other doctors mixed in Phlegm-Resolving Pills, Large and Small Xiantong Decoctions, etc., worsening the condition to near death. I was invited again. The pulse was extremely rapid and chaotic, with phlegm obstruction and hypochondriac pain, Qi and Blood disconnected. The syndrome was ruined; only heavy doses of Codonopsis Pilosula (Renshen) and Atractylodes Macrocephala Rhizome (Baizhu) could save him. First, I gave them thick porridge made from new grain, which relieved the chest oppression, gaining slight trust. They tried Renshen and Baizhu, resulting in sweating and passage of black stool, with spirit calming. However, cough with phlegm persisted, expectorating fresh blood. Hemorrhoids flared severely, unbearable pain, and splenic leakage occurred. The family suspected Renshen and Baizhu aided Fire. I said, "The dosage of Renshen and Baizhu was insufficient; they could not aid Fire to generate Earth." So I administered Codonopsis Pilosula (Renshen) 2 liang, Aconite Lateralis Radix Praeparata (Fuzi) 6 qian, Processed Ginger (Paojiang), Evodia Fruit (Wuzhuyu), Cinnamon Bark (Rougui), Psoralea Fructus (Buguzhi), Atractylodes Macrocephala Rhizome (Baizhu), Angelica sinensis (Danggui), and White Peony Root (Baishao). With sufficient dosage, after one dose, hemoptysis stopped, and hemorrhoid pain vanished. However, palpitations prevented sleep; inhalation felt cold as ice/snow even with boiling hot drinks. I formulated a tea substitute: Codonopsis Pilosula (Renshen) 2 liang, Prepared Rehmannia Root (Shu Dihuang) 2 liang, Processed Ginger (Paojiang) 3 qian, Processed Aconite (Fuzi) 6 qian, decocted strongly and drunk frequently. After ingestion, he could lie down. Daily, Shenfu Yangrong Tang (Codonopsis and Aconite Nourishing Harmony Decoction) was used, and Yuan Qi gradually recovered. At that time, Gufeng arrived in the county and we visited together. Gufeng asked Jingyuan, "Have you had children?" Jingyuan was shocked, "Will my illness never recover? Why ask this?" Gufeng said, "No. The Zang-Fu were over-purged with Mirabilite and Rhubarb, turning entirely deficient and cold. The source of life was damaged by drugs. Although cured, without warm tonification, fertility will be difficult." Thus, I often tell Yunhui: "Physicians treat people, not just diseases." Jingyuan was enlightened, saying, "Without you two, I nearly died. Appointing a physician is like appointing a general; it determines safety and danger. But only those who know deeply can trust firmly; only those who trust firmly can rely exclusively. One must observe carefully in peace to understand their depth, so that in crisis, one can trust fully and utilize their strengths. Waiting until thirsty to dig a well or fighting to forge weapons leaves one helpless in emergencies. Entrusting oneself to mediocre hands when desperate is the worst strategy. Observing the close relationship between the patient and Dongzhuang, yet lacking exclusive trust, nearly led to death by mediocre doctors—this is a lesson. Those who read this case and pay attention to prevention are wise, practicing 'treating disease before it arises' and 'chaos before it occurs.'"
This case was near death, yet Dongzhuang brought him back to life. Without such extraordinary measures, how could unexpected efficacy be achieved? Observing his tea substitute reveals the painstaking effort of a skilled artisan. "Physicians treat people, not just diseases" aligns deeply with the *Neijing*'s principle of seeking the root in treatment. Reflecting on the Changzhou cases reveals this clearly.
Qian Duizi, age five, had measles and diarrhea. Pediatricians believed toxin expulsion via diarrhea was best, disregarding caution, prioritizing clearing fire with cold-natured drugs, worsening the condition. I examined him: tender red cheeks, teeth grinding, wheezing, severe thirst, incessant drinking. Pulse was surging and slow, like a healthy adult. I said, "Spleen is critical. Quickly administer Codonopsis Pilosula (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), Angelica sinensis (Danggui), Astragalus Membranaceus Root (Huangqi), Tangerine Peel (Chenpi), Licorice Root (Gancao), Poria (Fuling), and Costus Root (Muxiang) to rescue." After one dose, he felt better. The next day, a neighbor advised against it, saying pediatricians specialize and Confucian scholars shouldn't treat children, citing dispersal and cooling for measles. Fearing this, the family stopped the medicine. Two days later, Qian Duizi returned, "Symptoms returned. What now?" I said, "Impossible. You jest." He explained he hadn't taken the medicine. I said, "Go home quickly; your son's 'Heavenly Pillar' (spine/posture) will collapse." Soon he rushed back, "It happened as you said. What to do?" I said, "Take the previous formula immediately." He asked, "Why call it deficiency-cold when cheeks are red, wheezing, and thirsty—all heat signs?" I said, "Yin exhausted internally, Yang scattered externally, compounded by cold drugs forcing Yang inward. Internal true cold, external false heat. This is Master Lizhai's interpretation of the *Neijing*; only those who deeply investigate can believe it." Qian Duizi returned, defying others, took the medicine. After one dose, posture straightened; after two, wheezing/thirst stopped; after three, he walked and played outside.
This case shows pediatric measles can involve Yang deficiency. Who says children are purely Yang and cannot benefit from Yang tonification?
Mr. Wu Huaya's servant contracted heat syndrome after returning from lake work in summer, with dysentery-like pus/blood discharge and burning body heat. I examined him: "This is Yangming disease, not dysentery. Tongue will be black and dry; delirium at night." Parents confirmed. Pulse was chaotic, intermittent like shrimp swimming—untreatable. Huaya insisted I treat, hoping for a miracle. I reluctantly used Prepared Rehmannia Root (Shu Dihuang) 1 liang, assisted by Raw Rehmannia (Sheng Dihuang), Ophiopogon Tuber (Maidong), Angelica sinensis (Danggui), White Peony Root (Baishao), Licorice Root (Gancao), and Goji Berry (Gouqizi). I warned: "Sweating indicates survival." Next day, fever persisted, delirium worsened, but bloody dysentery stopped. Slight sweat appeared briefly then ceased. I said, "Do not panic. Check pulse." Pulse was now distinct, surging and rapid. I rejoiced, "He lives." I continued the formula, removing Raw Rehmannia, adding Ziziphus Seed (Suanzaoren), Dioscorea Opposita Tuber (Shanyao), Cornus Fruit (Shanzhuyu), and Moutan Cortex (Danpi). Six doses later, family complained of persistent delirium/fever and demanded changes. I refused, promising recovery. Pulse became rounded and contained. I said, "Now I will remove the pathogen." Using Sishun Qingliang Yinzi (Four-Harmony Cooling Decoction) with Prepared Rehmannia Root (Shu Dihuang) 1 liang and Rhubarb (Dahuang) 5 qian, he passed dozens of black stools, and symptoms resolved. Two days later, evening: sudden delirium, fever, wheezing, thirst. Family panicked, expecting death. I laughed, "Unless you take mediocre doctors' meds, even swords won't kill him. Fear my words? Sweating brings life." I prescribed Atractylodes Macrocephala Rhizome (Baizhu) 1 liang, Astragalus Membranaceus Root (Huangqi) 1 liang, Dried Ginger (Ganjiang) 3 qian, Licorice Root (Gancao) 1 qian, Angelica sinensis (Danggui) and White Peony Root (Baishao) 3 qian each. After finishing, profuse sweating ensued, deep sleep until dawn, complete recovery. Someone asked, "Yangming heat requires rapid detoxification/purgation to preserve Yin. Why tonify first, then purge?" I said, "Toxic fire blazing fits Liange Chengqi indications, but originates from fatigue/Yang pathogen burning internally. Pulse lacks Yin. Purging abruptly traps toxin and exhausts Yin, causing death. Did you not hear of Scholar Xu treating typhoid? Fever, headache, thirst, floating/rapid pulse—Ma Huang Tang indication. But Ying Qi is deficient; do not sweat yet. First use Huangqi Jianzhong Tang. Family cursed the delay. Xu endured. On day five, Chi pulse responded, then Ma Huang Tang cured him. Physicians must consider exterior/interior, excess/deficiency, wait for timing. Disregarding sequence may bring temporary relief but damages Zang-Fu and shortens life. Southern History records Fan Yun fearing missing Emperor Wu's honors, demanding quick cure from Xu Wenbo. Wenbo said, 'Easy, but he dies in two years.' Yun insisted. Wenbo heated floor with peach leaves to induce sweat. Cured next day. Yun happy. Wenbo said, 'Don't rejoice; he dies in two years.' Inducing sweat prematurely shortens life; how much more dangerous to blindly purge ignoring Zang-Fu/pulse/symptoms?" Another asked, "Understood. But why did he relapse later, and you cured him with different meds?" I said, "Pathogen enters via Yang, exits via Yang. Now Yin Qi arrived but lacked movement to drive Ying-Wei harmony; no sweat means deficiency pathogen cannot exit, causing internal boiling/relapse. Tonify then purge, or tonify then sweat, both aim to clear pathogen after Qi returns. The principle 'enters via Yang, exits via Yang' advances past insights; only those mastering *Neijing* grasp its subtlety."
Niece of late friend Sun Zidu, married to Zhang, suffered miscarriage, cough, hemoptysis, rapid/choppy pulse, pale complexion, gastric fullness, splenic diarrhea. Doctors used Qi-regulating, fire-clearing, hemostatic drugs, worsening condition. I prescribed Lizhong Tang (Regulate the Middle Decoction) with Costus Root (Muxiang), Angelica sinensis (Danggui), and doubled Codonopsis Pilosula (Renshen) and Atractylodes Macrocephala Rhizome (Baizhu); bleeding stopped. Then Guipi Tang (Restore the Spleen Decoction) and Jiajian Bawei Yinzi (Modified Eight-Ingredient Decoction) gradually resolved symptoms. Gufeng came from the lake, examined, and said, "Great deficiency resolved thus thanks to Renshen/Baizhu. Mild cough and night fever remain; urgent warm tonification prevents future issues." Prescribed Jiajian Bawei Wan (Modified Eight-Ingredient Pill) morning, Jiagian Guipi Tang evening. Soon, a quack commented, "Blood disease stems from fire; how use hot drugs?" Switched to Lung-clearing, blood-cooling agents. Patient felt worse gastric distress, anorexia, forced to take meds due to public opinion. Month later, severe relapse, vomiting blood like a spring (purple/black/fresh). Patient resented, summoned me. I said, "Ruined. Zang-Fu forced by cold, Ying-Wei damaged, Water/Fire exhausted. Pulse exits but does not enter; disease progresses but does not retreat. Irreversible." She died shortly after. Renzhai Zhizhi says, "Deficient Ying Qi scatters, blood flows erratically. Yang deficiency leads to Yin wandering." Cao Shi Biyong Fang warns, "Taking Raw Rehmannia, Lotus Root Juice, Bamboo Shavings moves away from life." Ancient misunderstanding of "Yin-nourishing" killed. Quacks don't understand, casually prescribing "fire-clearing," unaware of what fire. Drugs seem mild but act like axes in guts. Terrifying. Even "tonify Qi for blood loss" is shallow; understanding Qi/Blood generation is harder. Surgery without skill yields zero survival. Benevolent hearts should heed this.
Patient care hinges on choosing a physician. Choosing is easy; trusting is hard. Trusting is easy; maintaining clarity in crisis without confusion is hardest. Ignoring this, listening to rumors, gathering many doctors, is like seeking a steed among inferior horses. In crisis, how bear mediocre errors? In ambiguity, how tolerate chaos? One wrong move costs a life. Many opinions lead to failure; many doctors guarantee defeat. If this case had exclusive trust, avoiding interference, why abandon success? Reading it makes me sigh.
Xu Luanhe's wife had cough; treated as wind-cold, worsened. I diagnosed deficiency pulse. Symptoms (stuffy nose, runny nose, phlegm) suggested excess wind-cold. I said, "True/false distinguished by pulse. Mediocre doctors miss this, killing many. Without pulse knowledge, judge by symptoms: tidal fever/cough worse at dusk, clearer at midnight, better at morning, correct?" She agreed. "Then deficiency is certain. The nasal symptoms are reassuring." Prescribed Codonopsis Pilosula (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), Angelica sinensis (Danggui), Astragalus Membranaceus Root (Huangqi), White Peony Root (Baishao) 3 qian each; Bupleurum Root (Chaihu), Ephedra Stem (Shengma) 1 qian each; Tangerine Peel (Chenpi), Licorice Root (Gancao), Schisandra Fruit (Wuweizi) 6 fen each. Three doses cured cough. Follow-up: leukorrhea severe, nearing metrorrhagia. Added Codonopsis Pilosula (Renshen), Psoralea Fructus (Buguzhi), Donkey-hide Gelatin (Ejiao) 2 qian each, plus Liuwei Wan (Six-Ingredient Pill). Cured.
Shen Songru of Nanhu asked, "Diagnosing deficiency from nasal symptoms is known. How did Dongzhuang see leukorrhea after cough resolved?" I said, "Dongzhuang found clues in the deficiency pulse/symptoms. Middle Qi generates Metal (Lung) and controls Water (Kidney)."