《医病简要》
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提要
《医病简要》一卷，书为裘君吉生得之于同社老友包君越瑚。包君申韩家而精歧黄学，退隐于医，历任绍兴医药学会评议员及会长，与著者张畹香先生世交也。本书系张氏在绍兴一生经验医案之录要，其用药之神，断诊之明，足资后学模范。因世之刊行医案，胥是多方药而少证论，且亦病繁芜而鲜精湛，本书虽了了数十则，然则则有简要之论，所谓少许胜人多许也。
《医病简要》序
张君畹香先生，家住绍城洗马池。读书时喜学医，博览群书。迨中年，求诊辄效，由亲戚而遍及陌路，著手成春，一时脍炙人口。忆余兄弟苕龄，时患病就医。尔时见张公与先父倾盖谈心，视其白发童颜，须长盈尺，年近古稀，此后不复再见。其哲嗣朴山先生，克绍薪传，虽不及乃父之声名广远，亦颇有妥当名誉，昕夕过从。今年秋，其贤孙晴岩兄前年由河南回来，出其乃祖手著《简要》并附医案两卷，凡伤寒、温邪、风温、热入血室、痢疾、疟疾、伏暑等证，分门别类，细阅一遍，爱不释手，其议论别有会心，衷诸古，而不泥古，俾后学一目了然，补前贤所未备，益后学于无穷，爰名其书曰《医病简要》。恨不醵资，付诸梨枣，以传后世。兹先述其得是书之缘起云尔。民国贰年腊月后学包越瑚谨撰时年五十有六岁
《医病简要》目录
舌苔 伤寒 温邪 风温 热入血室 痢暑 伏暑 瘄子
舌 苔
《张氏医通》内有伤寒舌鉴，图形议论颇详尽。然予见又有碧滑厚苔者。仓桥陈姓，年六十二，胸痛，粒食必吐，患经三月，脉弦小。用丁沉透膈散加参、术，令早起煎药，先眼二煎。食少许，觉欲吐，立服头煎，得不吐，则此法次第用之。午亥盖以药如钳然钳食，以药三月后，碧苔尽去，三餐皆食。凡伤寒温邪，或七日解，或十四日解，或二十一日解，全凭舌定。暑症或上焦，或中下焦，或三焦均感，或五日解，或十日解，或十五日解，亦以舌可定。得其窍不失迟早，合脉即死期，亦不爽迟早。又凡夏至后之湿邪与少阳经之暑湿症，其舌必中黄，四围白皆滑，又有冬春间，身热骨不痛，头不痛，舌净，脉沉弦小，卧床不能支。《张氏医通》谓为少阴症，须用黄蓍建中汤，甚或用四逆法者。予曾经见为疏芪蓍归建中，皆以为非。后竟以时手，不观舌而用承气，再邀求救，为不能治。
伤 寒
咸丰辛酉秋，予至阳嘉龙孙系治暑湿。彼地有时医，概用承气加以括蒌两许，滚痰丸，枳实，速其死。孙绍翁云，沿海人轻病，则不服药；若重病，经吾翁，必十五日始愈。或不愈，反不若彼之一剂危，两剂死之免医药费床褥债也，则作福，亦是无穷。吾于是顺天者之昌也。陕西人患伤寒，喜温通巴豆丸。河南人大黄可用至两许，川连不能服一钱，此总戎马佑庵先生告予也。总戒河南人，带兵足迹遍天下。本府山会用药相等。新嵊能服麻黄，萧诸喜温补，以地近杭省，习气相染也。苏杭人，柴胡、厚朴不能近一钱，苏人不服大黄，以金汁代之。凡医十三科，全者名全书，或专论伤寒者，名六书，如灵胎《六书》等类。或以中风列首，以风为百病之长也；又以伤寒列首，杂病次之。以仲景为医之祖，《伤寒》为一集，杂病《金匮要略》为一集也。予集前贤外感内伤，治法方药，名曰医针。于伤寒头绪颇繁，令人眩瞀，将以六经分说，不使稍混。因病中止，俟集成就庄，兹先呈治案数则。
陶姓，年七十外，王鸿轩先生之母舅也。正月初，水泻无度，神愤不能起立，诊脉空大，是伤寒直中太阴，以附子理中而愈。
香粉衡俞策兄。十一月，渠店夥屠越兄邀诊。身热、舌黄、喉干、舌干、齿浮、脉浮大，患经五六日，予知为阳明症。甫诊毕，其家已延以伤寒名者至。尔时，戚友趋拥人诊，开小柴胡杂以消导。盖此人只有小柴胡、达原、小承气，不论四时六气，舌苔有无黄白，皆此。其新人耳目者，枳壳、枳实、麻子仁、大黄、滚痰丸、厚朴。神曲、五谷虫、蒌仁，出入加减而已。予因言，此属阳明胃经，当用葛根汤。对曰：不特阳明，连太阳亦有。于方末加葛根一钱五分。予不觉喷饭，次日则用蒌仁、枳壳，十二三日，病不去。乃邀予治。其阳明经仍在，不传府，为疏葛根汤，两剂，身即凉。会稽明府耿修翁乃弟，十一月，水泻，痉厥，神呆，不省人事，脉沉弦小，舌净，身不热，已服过消导多多。予谓此直中太阴未罢，而传厥阴，用理中合人参吴茱萸汤，一剂水泻止，痉厥神呆如故。次日再诊，脉浮弦小，身热有微汗，自由厥阴转出少阳，当用小柴胡领邪外出。两剂神清，痉去，大便畅解，正七日云。
类伤寒中脚气，惟广东福建多患此，有死者。绍地惟馀姚、百官、会稽、东关一路有之，俗名大脚风。发作则有寒热，其病由于湿热，若初起以防己汤加苍术、牡蛎、泽泻治之可也。方书脚气入腹者死。曾见痛至少腹而死者。####温 邪 ####
道光己酉三四月，城乡温邪盛行，予以吴氏条辨法颇效。锦鳞桥范合家，病三十余人，并其戚被染者，经予一手治愈。尔时昼夜赴救，往往枵腹从事，致感染合家，幸予预制紫雪丹，无论人我，均效。缘邪生每犯心宫，则危见机，早用为要。次年庚戌，温邪尤盛，以连岁太潦，平地水高数尺，五谷不登，遂致奇荒，荒年以后，必有温疫也。于是益信又可饱腹不病之说。遂不复染。
昌安街董，五月病温，五六日，舌鲜红，呃逆，脉沉小弦数，神昏，口舌燥，不饮水。予谓邪在血分，将发斑也。用玉女煎，石膏加至一两，麦冬五钱，根生地一两，犀角一钱五分，磨冲羚角三钱，复大青以托斑，柿蒂以除呃，两剂癍出神清。
府桥泥水匠钟大成，舌鲜红，呃逆，脉洪数，面红气盛。是邪在心肺上焦，黄芩汤加大力、甘、桔、根生地一两，生石膏二两，麦冬五钱，犀角、羚羊角、柿蒂两剂，呃除身凉。
营桥丁，发颐大如马刀，喉赤肿痛，舌黄厚，脉数大。《说疫》所谓疙瘩瘟也。病经十余日，由于失下，普济消毒以人中黄易甘草，加制大黄五钱，不应，加至八钱，大圊血而解。(黄芩黄连 陈皮 甘草 元参 连翘板蓝根 牛蒡 薄荷 僵蚕 升麻 柴胡桔梗 马勃 或加人参。便闭加大黄。)
孙府孙病十余日，舌白薄，脉浮数，所服初则达原，继则承气。余谓此属上焦症，误用中焦，故不效。用辛凉法加生石膏、羚角，大汗而愈。
教场沿高，病温多日，舌白薄，神昏迷，口不渴，脉伏小。予谓邪在上焦，将欲作汗，须领邪外出。黄芩汤加薄荷、大力、羚角、石膏、甘桔一剂。次日，大汗，大渴，饮水无度，胸腹胀满，小便不通。用白虎汤加瓜蒌皮一两、带皮茯苓一两一剂，小溲如注而解。(石膏知母甘草 粳米)
杜元亨，舌黄厚，周身发黄，胸痛拒按，气喘不能卧而坐。自述病前多食厚味。黄芩汤合调胃承气加厚朴三钱，枳实二钱，川连二钱，绵茵陈、栀子，三剂，大便畅解，黄去身凉，
范可斋，四月间，上焦温邪，用辛凉法，战汗体冷，如冰人，不能支。又可所谓体厥也。诊脉静小。余嘱其家勿惊扰，疏沙参、麦冬、根生地、花粉等滋肺而愈。盖书以汗后脉如蛇者死。若沉部似有似无亦当死。又云，脉不为汗下减者死。上城隍庙道士，温邪，舌黄，脉沉小无力。予谓明日当战汗，脉太弱，恐战而不得汗也。次日果作战不汗而死。
螺蛳桥一人，前一日，诊脉沉小。予谓明日当战汗，若体厥，切勿惊扰。次日汗后，奄奄一息，脉静小，疏大剂滋肺汤。甫出门，其家又延一有名者至，以予药为补，用承气汤，服之即死。
又治一人，黄昏大躁，尽去衣服，忽作冷，穿衣盖被，复大战，如作疟状。至天明，大汗淋漓，衣服如水中捞起。下午诊脉尚浮数，身尚热，舌苔尚有白薄者。予谓邪未净，尚有汗，用滋肺汤；寐中又盗汗，两三夜邪始净。
大坊口赵，患温邪三日，其两脚大痛，不能起立。予谓《说疫》中所云瓜瓤瘟、疙瘩瘟、大头瘟，皆有方。又有极重者，谓之软脚瘟，患必死，无方也。然予思，总由肾水之虚，肝家血分之热用张石顽先生下焦肝痛方，如炒小茴香一钱五分、川楝子三钱、酒延胡一钱五分，于黄芩汤中。三剂后，足痛去，温邪亦渐瘥。嗣后无论男妇，遇软脚瘟，用此法俱效。
大坊口赵妇，产三日后患温邪。予遵张石顽先生论，凡遇胎前产后，所患不拘何病，总以胎产为本，以病为标。名病为产后患温邪，产后当理血分，以根生地凉其血，赤芍、川芎通其血，以薄荷、桔梗、川连、甘草辛凉其肺。而黄芩、白芍产后所禁，不用。不过四剂，乃愈。
凡温邪，或暑湿，一见舌尖鲜红，即为邪走心包，速须紫雪，截其来路。如神至昏痉，多用亦难见效。宗涤翁郎，似青质，弱午时，脉无神，予与刘友仙二兄深虑之。道光庚戌六月，患温四五日，辰刻诊。予谓其戚王珠翁云，此症下午必入心包，紫雪香散恐不克当。不得已，用人参汤送，迟则不救。予以原料紫雪付之，不即服。黄昏痉厥，大汗，起立无常，脉虚小。予覆以不治。殊不知珠翁之夫人，为涤翁之妹，三月间患温邪，予以紫雪治愈。是年温邪犯心，即危见机，早用或效。或问，何以与又可法不同予谓嘉庆年间，所谓任大黄者，用又可大剂承气得效，以天运交七赤八白，七赤属大肠金，八白属脾土，今则交九紫，火属心，故邪亦走心包，即肝厥肝痛之多，且甚者亦由心火盛，盗其母气，肝虚易于致病。鸦片烟之盛行，舒其肝郁耳。明万历平间，闽人至京售一粒金丹，所称阿芙蓉，即莺粟浆也。惟任翁用又可法，大发财，名为伤寒世家，其实真正伤寒辨经别络，恐难雪亮也。城乡各镇，尤而效之，不过达原一饮，承气一汤，复以消导，逐秽不分，四时百病概谓伤寒。无论老幼强弱，均用此法。无论舌苔有无与黄白，无不攻消。于是人人知医，个个插嘴，其术愈卑，其业愈晓。孔子云：小道必有可观。今则小之欲无，观之没有，故有志者，遁而之他，万不习医，而医乃绝。
风 温
道光年间，钱友，三三月间患风温十余日，始邀予。舌干红起绉，按之无液，与喉唇皆燥，难忍，不寐，身灼热无汗，咳痰不出，脉小数。予谓此属上焦症，由过服消导发散所致。用根生地两许、元参、麦冬、玉竹、沙参、丹皮、桑叶、蔗浆七八剂而愈。
同治甲子二月，偏门谢患风温十余日，身热，舌鲜红，咳痰不出，呕吐不得食，脉浮洪大，是邪在上焦，误服小承气与调胃承气，正合《伤寒论》不应下而下之，致成结胸，用泻心汤。用生姜泻心汤，先除其呕；继用黄芩、葳蕤等汤加减而愈。
仓桥孔小山先生，乙丑冬季，年八十四，患风温多日，身热无汗，舌黑，口齿燥甚，大便水泻，脉洪大，是其本色。盖高年未有脉不洪大，为六阳者也。阅所服，是葶苈、苏子等泻肺，杂以消导。致邪陷下焦，故不得汗。不得汗则身不得凉。今津液已涸，当救其阴，用黄芩汤，复以增液汤。泻止，再以葳蕤汤，得汗身凉。
治一孩，三岁，二月间，辰刻身热，嗜卧，呼唤不醒，至黄昏，惟闻喉间痰声壅塞，水浆不入，予以马勃一两，以病起勃然，故用勃然而兴之药，碎为小块，纱包铁物压煎，又以箸掉以手揉，缘轻浮之物不易煎汁耳。煎数大碗。将孩抱起，仰天灌一瓢，闻喉中声尤响，逾时向地倾之，又灌，又倾。二更后，喉忽开，大叫乃醒。天明不出汗，身凉，竟不服药。
又治世侄范定甫。甫周岁三月，患风温，越五十日，气绝，委诸地，尚温，又抱之。予诊脉小数，虎口纹紫细，直透三关，舌黑燥。其祖母嘱母开方，以逢药食必吐。绝食已一月。予问：不食何以活云：见碗必欲饮，饮水泻水耳。因思药之如茶水者，必不吐。于是以病久气虚，用燕窝一两，以代元参、麦冬，羚角，竹叶以代川连，黑橹豆皮一两以代地黄，茯苓、通草以通小溲，皆无药气味者，恣饮之三日。舌黑为黄，溲通泻差。再三日，竟愈，食粥饭，至今抱子多多。
水沟营冯朴园姻兄，二月间在诸幕中，身热咳喘，病如伏寒。路间又感风雨，至家则诸筋络掣痛，失红，脉弦数，舌黄薄，是肺卫心营皆感。然营较卫为重，当先治其红，用根生地一两，麦冬、银花、羚角、山茶花、丝瓜络、元参、赤芍、丹、桑，两剂红止，再以凉解卫分风热，身凉而愈。
乙丑十一月，朱石翁，年七十三，身热咳嗽，左胁大痛，脉弦右尤弦且大，谓是为风温夹肝症，怕失红耳。次日果失红。用葳蕤汤减去麻黄、石膏，加羚角、丹、桑、元参、麦冬，复以牡蛎、柴胡梢、鳖甲、降香、苏子、赤芍，又令以藕汁、甘蔗汁代茶水，调养即愈。###热入血室###
道光庚戌六月，水澄巷王元通一妇，患温邪六七日，适逢经至。予为道贺，即用前法。其本家有知医者，谓通经当用温药，改为炮姜、红花等剂，经即停，叫掷烦躁，一夜即死。
*Yi Bing Jian Yao* (Brief Summary of Medical Treatment for Patients)
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Abstract
*Yi Bing Jian Yao* consists of one volume. This book was obtained by Mr. Qiu Jisheng from his old friend and fellow society member, Mr. Bao Yuehu. Mr. Bao was proficient in the School of Law (Shen-Han) and deeply versed in Qi-Huang studies (Traditional Chinese Medicine). After retiring from official life, he engaged in medical practice and served as a councilor and later president of the Shaoxing Pharmaceutical Society. He was a family friend of the author, Mr. Zhang Wanxiang. This book records the essential clinical cases of Mr. Zhang's lifelong medical experience in Shaoxing. The miraculous efficacy of his herbal prescriptions and the clarity of his diagnostic reasoning serve as models for future students. Since most published medical case records circulating in the world tend to list numerous herbs while lacking discussion on syndrome differentiation, and often present complicated and verbose descriptions without profound insight, this book, though containing only dozens of cases, offers concise and essential discussions in each entry. As the saying goes, "A little bit is better than a lot."
Preface to *Yi Bing Jian Yao*
Mr. Zhang Wanxiang resided at Xima Chi in Shaoxing City. During his student years, he had a fondness for studying medicine and read extensively. By middle age, his consultations were invariably effective; initially treating relatives and friends, he eventually treated strangers. His skill was so adept that it seemed like spring arriving with a touch, gaining him widespread fame. I recall my brother, Tiaoling, seeking treatment for an illness at that time. I saw Mr. Zhang conversing intimately with my late father. Observing his white hair yet youthful complexion, and a beard reaching a foot in length, he was nearly seventy years old. We did not see him again after that. His son, Mr. Pushan, inherited his father's medical legacy. Although his reputation was not as extensive as his father's, he maintained a respectable standing, and we interacted frequently day and night. This autumn, his virtuous grandson, Brother Qingyan, returned from Henan two years prior and presented manuscripts written by his grandfather, *Jian Yao*, along with two volumes of medical cases. Covering syndromes such as Shanghan (Cold Damage), Wenxie (Warm Pathogens), Fengwen (Wind-Warmth), Re Ru Xue Shi (Heat Entering the Blood Chamber), Li Ji (Dysentery), Nüe Ji (Malaria), and Fu Shu (Latent Summerheat), they were categorized meticulously. Upon reading them thoroughly, I found them irresistible. The discussions revealed unique insights, aligning with ancient principles without being bound by them, allowing future students to understand clearly at a glance. They supplemented what previous sages had omitted and benefited learners infinitely. Thus, I named the book *Yi Bing Jian Yao*. I regret not having raised funds to have it printed and passed down to posterity. Here, I first describe the origin of obtaining this book. Written by humble learner Bao Yuehu in the twelfth lunar month of the second year of the Republic of China, aged fifty-six.
Table of Contents for *Yi Bing Jian Yao*
Tongue Coating | Shanghan (Cold Damage) | Wenxie (Warm Pathogens) | Fengwen (Wind-Warmth) | Re Ru Xue Shi (Heat Entering the Blood Chamber) | Li Shu (Dysentery and Summerheat) | Fu Shu (Latent Summerheat) | Ma Zi (Smallpox/Measles)
Tongue Coating
In *Zhang Shi Yi Tong* (Medical Secrets of Mr. Zhang), there is a section on tongue diagnosis in Shanghan, with detailed diagrams and discussions. However, I have also seen cases with thick, greenish, slippery tongue coating. A patient surnamed Chen from Cangqiao, aged sixty-two, suffered from chest pain and vomiting immediately upon eating any amount of food. Having been ill for three months, his pulse was wiry and small. I prescribed Dingchen Touge San (Cardamom and Amber Decoction to Unblock the Diaphragm) added with Renshen (Ginseng) and Baizhu (Atractylodes Macrocephala Rhizome). Instructed him to decoct the medicine early in the morning and take the second decoction first. After eating a small amount, when he felt the urge to vomit, he immediately took the first decoction and stopped vomiting. This method could be applied sequentially. From Wu hour (11 am-1 pm) to Hai hour (9 pm-11 pm), the medicinal effect acted like a clamp holding the food. After three months of medication, the green coating completely disappeared, and he could eat three meals a day. For all cases of Shanghan or Wenxie, resolution may occur in seven days, fourteen days, or twenty-one days, determined entirely by the tongue. For Summerheat syndromes, whether affecting the Upper Jiao, Middle/Lower Jiao, or all three Jiaos, resolution may occur in five, ten, or fifteen days, also determined by the tongue. Mastering this key prevents errors in judging the timing. Combined with pulse diagnosis, even the time of death can be predicted accurately without error. Furthermore, for damp pathogens after the Summer Solstice and Summerheat-dampness syndromes of the Shaoyang Meridian, the tongue coating must be yellow in the center and white and slippery around the periphery. There are also cases in winter and spring where the body feels hot but bones do not ache, the head does not hurt, the tongue is clean, and the pulse is deep, wiry, and small, leaving the patient unable to support themselves lying in bed. *Zhang Shi Yi Tong* classifies this as Shaoyin Syndrome, requiring Huangqi Jianzhong Tang (Astragalus and Decocted Grain Decoction), or even Sini Fa (Method of Reversing Yin/Cold). I once saw someone prescribe Huangqi Dangui Jianzhong Tang carelessly, which everyone considered incorrect. Later, contemporary physicians, ignoring the tongue, used Chengqi Tang (Purgative Decoctions), and when invited again for rescue, declared it incurable.
In the autumn of Xinyou year during the Xianfeng reign, I went to Yangjia Long Sunxi to treat Summerheat-dampness. Local quacks generally used Chengqi Tang (Purgative Decoctions) plus Gua Lou (Trichosanthes Fruit) up to two taels, Guntan Wan (Rolling Phlegm Pills), and Zhishi (Immature Bitter Orange), accelerating patients' deaths. Old Man Sun Shaowei said, people in coastal areas do not take medicine for mild illnesses; if seriously ill and treated by me, they must wait fifteen days to recover. If they do not recover, it is better than their current state of one dose causing critical danger and two doses causing death, thereby avoiding medical fees and bedding debts. This is also a form of blessing, infinite in its own way. Thus, I follow those who prosper according to Heaven's will. People in Shaanxi suffering from Shanghan prefer warm unblocking methods using Badou Wan (Croton Seed Pills). People in Henan can use Dahuang (Rhubarb Root and Rhizome) up to one tael, but cannot tolerate Chuanlian (Coptis Rhizome) even one qian. This was told to me by General Ma You'an. General warned against Henan people, whose military service covered the whole country. Medication usage in the prefecture's Shan and Hui counties is comparable. Xinsheng can tolerate Mahuang (Ephedra Herb); Xiaozhu prefers warm tonification because the region is close to Hangzhou, and habits influence each other. People in Suzhou and Hangzhou cannot tolerate Chaihu (Bupleurum Root) or Houpo (Magnolia Bark) near one qian; Suzhou people do not take Dahuang, replacing it with Jinzhi (Gold Juice). Physicians specializing in all thirteen departments are called "Complete Books," or those focusing solely on Shanghan are called "Six Books," such as Lingtai's *Six Books*. Some list Zhongfeng (Wind Stroke) first, as wind is the chief of hundred diseases; others list Shanghan first, followed by miscellaneous diseases. Viewing Zhang Zhongjing as the ancestor of medicine, *Shanghan Lun* (Treatise on Cold Damage) is one collection, and miscellaneous disease *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) is another. I collected external contraction and internal injury treatments, methods, formulas, and herbs from former sages, naming it *Yi Zhen* (Medical Needle). Shanghan has many threads, confusing people. I intended to explain it via the Six Channels to avoid confusion. Interrupted by illness, waiting until completion to present solemnly, here I first present several treatment cases.
Patient surnamed Tao, over seventy years old, maternal uncle of Mr. Wang Hongxuan. In the first lunar month, suffered from profuse watery diarrhea, mental agitation, unable to stand. Pulse was empty and large. This was Shanghan directly invading the Taiyin (Spleen/Stomach) channel. Cured with Fuzi Lizhong Tang (Aconite and Center-Regulating Decoction).
Brother Yu Ce from Xiangfen Heng. In November, his shop assistant Brother Tu Yue invited consultation. Symptoms: fever, yellow tongue coating, dry throat, dry tongue, floating teeth, floating and large pulse. Ill for five or six days. I knew this was Yangming Syndrome. Just as I finished diagnosing, his family had already invited a doctor famous for treating Shanghan. At that time, relatives and friends crowded to get diagnosed. They prescribed Xiao Chaihu Tang (Minor Bupleurum Decoction) mixed with digestive aids. Basically, this person only knew Xiao Chaihu Tang, Dayuan Yin (Origin-Reaching Drink), and Xiao Chengqi Tang (Minor Purgative Decoction), regardless of the four seasons or six qi, and regardless of whether the tongue coating was yellow or white. What seemed novel to others were Zhike (Aurantii Fructus), Zhishi (Immature Bitter Orange), Maziren (Hemp Seed), Dahuang (Rhubarb Root and Rhizome), Guntan Wan (Rolling Phlegm Pills), Houpo (Magnolia Bark), Shenqu (Medicated Leaven), Wugu Chong (Silkworm), and Louren (Trichosanthes Seed), merely varying additions and subtractions. I stated this belongs to the Yangming Stomach meridian and should use Gegen Tang (Kudzu Decoction). He replied: Not only Yangming, but also Taiyang (Bladder) is involved. Added Gegen (Kudzu Root) one qian five fen to the end of the formula. I couldn't help laughing. The next day, they used Louren and Zhike. By the twelfth or thirteenth day, the illness remained. Then they invited me to treat. The Yangming meridian pathogen was still present, not having transmitted to the Fu organs. I prescribed Gegen Tang. Two doses, and the body cooled.
Younger brother of Geng Xiu, Prefect of Kuaiji. In November, watery diarrhea, spasms and convulsions, mental dullness, unconsciousness. Pulse deep, wiry, and small. Tongue clean. No fever. Had taken many digestive aids. I said this is direct invasion of Taiyin not yet resolved, transmitting to Jueyin (Liver/Pericardium). Used Lizhong Tang combined with Renshen and Wuzhuyu Tang (Evodia Decoction). One dose stopped the diarrhea; spasms and mental dullness remained unchanged. Diagnosed again the next day: pulse floating, wiry, and small. Body heat with slight sweating. Naturally transitioning from Jueyin to Shaoyang (Gallbladder). Should use Xiao Chaihu Tang to lead the pathogen out. Two doses: mind cleared, spasms ceased, bowel movement smooth. Exactly seven days.
Among conditions resembling Shanghan, Foot Bi (Gout/Paralysis) is common in Guangdong and Fujian, with fatalities. In Shaoxing, it occurs only in Yuyao, Baiguan, Kuaiji, and Dongguan routes, commonly called Da Jiao Feng (Big Foot Wind). Onset involves chills and fever. Etiology is damp-heat. If treated early with Fangji Tang (Stephania Decoction) added with Cangzhu (Atractylodes Lancea Rhizome), Muli (Oyster Shell), and Zexie (Alisma Rhizome), it can be cured. Medical texts state Foot Bi entering the abdomen leads to death. I have seen cases dying with pain extending to the lower abdomen.####Wenxie (Warm Pathogens)####
In the third and fourth lunar months of Jiyu year during the Daoguang reign, Wenxie prevailed in urban and rural areas. My application of Wu's Clause Method was quite effective. In Jinlin Bridge, Fan family, over thirty members fell ill, including infected relatives. I cured them all personally. Day and night rescue efforts often left me fasting, leading to infection of my own family. Fortunately, I had prepared Zixue Dan (Purple Snow Pill) in advance. Regardless of whether it was for me or others, it was effective. Because pathogens often invade the Heart Palace, danger appears quickly; seizing the opportunity to use it early is crucial. In the following year, Gengxu, Wenxie was even more prevalent. Due to consecutive years of heavy rain, floodwaters rose several feet above ground level, crops failed, causing extreme famine. Following a famine year, epidemic warm diseases inevitably arise. Thus, I further believed in Keyou's theory that full bellies prevent disease. Consequently, I did not get infected.
Dong from Chang'an Street. Fell ill with Wen in May. After five or six days, tongue was bright red, hiccups, pulse deep, small, wiry, and rapid. Mental confusion, dry mouth and tongue, no desire to drink. I said the pathogen is in the Blood Level, about to manifest macules. Used Yuniu Jian (Jade Woman Decoction). Increased Shigao (Gypsum Fibrosum) to one tael, Maidong (Ophiopogon Tuber) five qian, Genshengdi (Rehmannia Root) one tael, Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) one qian five fen, ground and mixed with Lingjiao (Antelope Horn) three qian. Added Daqingye (Isatis Leaf) to push out macules, Shidi (Persimmon Calyx) to stop hiccups. Two doses: macules appeared, mind cleared.
Zhong Dacheng, a mason from Fuqiao. Bright red tongue, hiccups, flooding and rapid pulse, red face, vigorous breath. Pathogen in the Heart and Lungs, Upper Jiao. Huangqin Tang (Scutellaria Decoction) added with Dalì (Aster Root), Gancao (Licorice Root), Jiegeng (Platycodon Root), Genshengdi one tael, Sheng Shigao (Raw Gypsum Fibrosum) two taels, Maidong five qian, Xijiao (Rhinoceros Horn), Lingyangjiao (Antelope Horn), Shidi (Persimmon Calyx). Two doses: hiccups stopped, body cooled.
Ding from Yingqiao. Parotid swelling as large as a horse's neck, red and swollen painful throat, thick yellow tongue coating, rapid and large pulse. Known in *Shuo Yi* (Discussion on Epidemics) as Gedawe (Lump Plague). Ill for over ten days due to failure to purge. Puji Xiaodu Yin (Universal Relief and Toxin-Resolving Drink) substituted Renzhonghuang (Human Excrement Yellow) for Gancao (Licorice Root), added Zhi Dahuang (Prepared Rhubarb Root and Rhizome) five qian. Ineffective, increased to eight qian. Profuse bloody stool ensued, then resolved. (Huangqin Scutellaria Root, Huanglian Coptis Rhizome, Chenpi Tangerine Peel, Gancao Licorice Root, Yuan Shen Polygala Root, Lianqiao Forsythia Fruit, Banlangen Isatis Root, Niubiu Arnebia Root, Bohe Mentha Herb, Jiangcan Bombyx Batryticatus, Shengma Cimicifuga Rhizome, Chaihu Bupleurum Root, Jiegeng Platycodon Root, Mabo Wood Ear Mushroom. Or add Renshen Ginseng. If constipation, add Dahuang.)
Sun from Sun Mansion. Ill for over ten days. Thin white tongue coating, floating and rapid pulse. Initially took Dayuan Yin, then Chengqi Tang. I said this is an Upper Jiao syndrome, mistakenly treated with Middle Jiao methods, hence ineffective. Used Xinliang Fa (Acrid-Cool Method) added with Sheng Shigao (Raw Gypsum Fibrosum) and Lingjiao (Antelope Horn). Profuse sweating ensued, then recovered.
Gao Yan from Jiaochang. Ill with Wen for many days. Thin white tongue coating, mental coma, no thirst, hidden and small pulse. I said pathogen is in Upper Jiao, about to sweat. Must lead pathogen out. Huangqin Tang added with Bohe (Mint Herb), Dalì (Aster Root), Lingjiao (Antelope Horn), Shigao (Gypsum Fibrosum), Gancao (Licorice Root), Jiegeng (Platycodon Root). One dose. Next day: profuse sweating, extreme thirst, drinking excessively, chest and abdominal distension, inability to urinate. Baihu Tang (White Tiger Decoction) added with Gualou Pi (Trichosanthes Peel) one tael, Daipi Fuling (Poria with Skin) one tael. One dose: urine flowed like a stream, then resolved. (Shigao Gypsum Fibrosum, Zhimu Anemarrhena Rhizome, Gancao Licorice Root, Jingmi Rice Grain)
Du Yuanheng. Thick yellow tongue coating, whole body jaundiced, chest pain refusing pressure, panting unable to lie down, sitting instead. Reported excessive consumption of rich foods before illness. Huangqin Tang combined with Wei Chengqi Tang (Stomach-Regulating Purgative Decoction) added with Houpo (Magnolia Bark) three qian, Zhishi (Immature Bitter Orange) two qian, Chuanlian (Coptis Rhizome) two qian, Mian Yinchén (Artemisia Capillaris Herba), Zhizi (Gardenia Fruit). Three doses: bowel movement smooth, jaundice cleared, body cooled.
Fan Kezhai. In April, Upper Jiao Wenxie. Used Xinliang Fa (Acrid-Cool Method). Battle sweat occurred, body cold as ice, unable to bear. This is what Keyou calls Tijué (Body Cold Shock). Pulse quiet and small. I instructed the family not to panic. Prescribed Shashen (Glehnia Root), Maidong (Ophiopogon Tuber), Genshengdi (Rehmannia Root), Huafen (Trichosanthes Root) to nourish the Lung. Recovered. Texts say pulse like a snake after sweating indicates death. If deep pulse seems present or absent, also indicates death. Also, pulse not reduced by sweating or purging indicates death.
Daoist priest from Shangcheng City God Temple. Wenxie. Yellow tongue coating, deep, small, and weak pulse. I said battle sweat would occur tomorrow. Pulse too weak, fearing battle without sweat. Next day: indeed battled but no sweat, then died.
Person from Luosi Bridge. Previous day, pulse deep and small. I said battle sweat would occur tomorrow. If body cold shock occurs, do not panic. Next day after sweat: barely breathing, pulse quiet and small. Prescribed large dose of Zifei Tang (Nourishing Lung Decoction). Just as I left, family invited another famous doctor. He considered my prescription tonic and used Chengqi Tang. Patient died immediately after taking it.
Treated another person. Extreme restlessness at dusk, removed all clothes. Suddenly felt cold, put on clothes and quilt. Then severe shaking, resembling malaria. By dawn: profuse sweating, clothes soaked as if pulled from water. Afternoon pulse still floating and rapid, body still hot, tongue coating still thin white. I said pathogen not cleared, sweating continues. Used Zifei Tang (Nourishing Lung Decoction). Night sweats continued during sleep. Pathogen cleared after two or three nights.
Zhao from Dafangkou. Ill with Wenxie for three days. Severe pain in both legs, unable to stand. I said in *Shuo Yi*, Guawang Plague, Gedawe (Lump Plague), Datou Plague (Big Head Plague) all have formulas. There is also a very severe type called Ruanjiao Plague (Soft Leg Plague), which is fatal with no formula. However, I reasoned it stems from Kidney Water deficiency and Heat in Liver Blood level. Used Mr. Zhang Shiwen's Lower Jiao Liver Pain Formula: Chao Xiaohuixiang (Fennel Seed) one qian five fen, Chuanlianzi (Toosendan Fruit) three qian, Jiu Yanhu (Cyathula Root) one qian five fen, added to Huangqin Tang. After three doses, leg pain ceased, Wenxie gradually improved. Subsequently, regardless of gender, this method was effective for Ruanjiao Plague.
Wife of Zhao from Dafangkou. Fell ill with Wenxie three days postpartum. Following Mr. Zhang Shiwen's theory, for pre- and postpartum illnesses, regardless of the disease, always treat pregnancy/birth as root and disease as branch. Named the condition Postpartum Wenxie. Postpartum requires regulating Blood Level. Used Genshengdi (Rehmannia Root) to cool blood, Chishao (Red Peony Root) and Chuanxiong (Szechwan Lovage Rhizome) to move blood, Bohe (Mint Herb), Jiegeng (Platycodon Root), Chuanlian (Coptis Rhizome), Gancao (Licorice Root) to acrid-cool the Lung. Huangqin (Scutellaria Root) and Baishao (White Peony Root) are contraindicated postpartum, so not used. Four doses, then recovered.
For all Wenxie or Summerheat-Dampness, once the tongue tip is bright red, it indicates pathogen moving to the Pericardium. Immediately use Zixue (Purple Snow) to intercept the pathogen's approach. If mental confusion and spasms occur, even heavy use may be ineffective.
Son of Zong Diyong. Constitution similar to Qingzhi (Clear Quality). Weak at noon, pulse lacked spirit. Brother Liu Youxian and I worried deeply. In June of Gengxu year during Daoguang reign, ill with Wen for four or five days. Diagnosed at Chen hour (7-9 am). I told his relative, Mr. Wang Zhu, "This syndrome will enter the Pericardium in the afternoon. Zixue Xiang San (Purple Snow Fragrant Powder) may not suffice. Reluctantly, use Renshen Tang (Ginseng Decoction) to deliver [the medicine]. Delay means no rescue." I provided raw material Zixue, but it was not taken immediately. At dusk: spasms and convulsions, profuse sweating, erratic standing, pulse empty and small. I reviewed and deemed it incurable. Little did I know Mr. Zhu's wife was Sister Diyong's sister. She had fallen ill with Wenxie in March, cured by me using Zixue. That year, Wenxie invaded the Heart. Danger appears quickly; early use might be effective. Someone asked, "Why different from Keyou's method?" I said: In the Jiaqing era, so-called Ren Dahuang used Keyou's large dose Chengqi Tang effectively. This was because the heavenly cycle shifted to Seven Red and Eight White. Seven Red belongs to Large Intestine Metal; Eight White belongs to Spleen Earth. Now it shifts to Nine Purple. Fire belongs to Heart. Thus, pathogens also move to the Pericardium. Hence, many cases of Liver Jue and Liver Pain. Severe cases also stem from excessive Heart Fire robbing Mother Qi (Wood), making Liver deficiency prone to disease. The prevalence of Opium Smoke soothes Liver Stagnation. During Ming Wanli era, Fujian people sold Yili Jindan (One Pill Golden Elixir) in Beijing, called Afulou, which is Poppy juice. Only Mr. Ren used Keyou's method, made great fortune, named a Shanghan family. Actually, true Shanghan distinguishing meridians and collaterals is hard to verify. Towns and villages imitated this, merely using Dayuan Yin and Chengqi Tang, plus digestive aids. Purging filth indiscriminately, categorizing all hundred diseases of four seasons as Shanghan. Regardless of age, strength, or weakness, all used this method. Regardless of tongue coating presence or color (yellow/white), all attacked and eliminated. Thus, everyone claimed to know medicine, everyone interjected. Their skills became meaner, their profession more obscure. Confucius said: Even minor arts have something worth observing. Now, the minor art wants to disappear, observation is gone. Thus, those with aspirations flee elsewhere, ten thousand times unwilling to study medicine, and medicine becomes extinct.
During Daoguang reign, Friend Qian. In the third lunar month, ill with Fengwen for over ten days before inviting me. Tongue dry, red, wrinkled, no fluid upon pressing. Throat and lips dry, unbearable. Insomnia. Body burning hot, no sweat. Cough with phlegm stuck. Pulse slightly rapid. I said this is Upper Jiao syndrome, caused by overuse of digestive and dispersing agents. Used Genshengdi (Rehmannia Root) one tael, Yuan Shen (Polygala Root), Maidong (Ophiopogon Tuber), Yuzhu (Polygonatum Odoratum Rhizome), Shashen (Glehnia Root), Danpi (Moutan Cortex), Sangye (Mulberry Leaf), Zhejiang (Sugarcane Juice). Seven or eight doses, then recovered.
Xie from Pianmen during Tongzhi Jiazi February. Ill with Fengwen for over ten days. Fever, bright red tongue, cough with stuck phlegm, vomiting unable to eat. Pulse floating, flooding, and large. Pathogen in Upper Jiao. Mistakenly took Xiao Chengqi Tang and Tiaowei Chengqi Tang. Matches *Shanghan Lun*: purging when not indicated, leading to Jiexiong (Glomus Accumulation). Used Xiexin Tang (Drain the Epigastrium Decoction). Used Shengjiang Xiexin Tang (Fresh Ginger Drain the Epigastrium Decoction) first to stop vomiting; then used Huangqin (Scutellaria Root), Weirui (Anemarrhena Rhizome) etc., modified, then recovered.
Mr. Kong Xiaoshan from Cangqiao. Winter of Yichou year, aged eighty-four. Ill with Fengwen for many days. Fever, no sweat, black tongue, extremely dry mouth and teeth, watery diarrhea. Pulse flooding and large, his natural constitution. Elderly people rarely have pulses not flooding and large; this is Six Yang. Reviewed medications taken: Tingli (Descurainia Seed), Su Zi (Perilla Fruit) etc., lung-draining, mixed with digestive aids. Caused pathogen to sink to Lower Jiao, hence no sweat. No sweat means body cannot cool. Now fluids exhausted, must save Yin. Used Huangqin Tang, then Zengye Tang (Increase Fluids Decoction). Diarrhea stopped, then used Weirui Tang. Sweating ensued, body cooled.
Treated a child, three years old. February, Chen hour (7-9 am) fever, lethargy, unresponsive to calling. By dusk, only heard phlegm rattling in throat, unable to take fluids. Used Mabo (Wood Ear Mushroom) one tael. Since the illness arose suddenly ("boran"), used a herb with "boran" (arising) nature. Crushed into small pieces, wrapped in gauze, pressed with iron object to decoct. Stirred with chopsticks and hand kneaded, because light-floating materials are hard to decoct. Decocted several large bowls. Held the child, tilted head back, poured one ladle. Heard louder phlegm sound in throat. After some time, tilted towards ground, poured again, tilted again. After Second Watch (1-3 am), throat suddenly opened, cried loudly, then woke. Dawn: no sweat, body cooled, refused further medicine.
Treated nephew Fan Dingfu. Just past one year three months old. Ill with Fengwen. Over fifty days later, breath stopped, laid on ground, still warm, picked up again. Pulse slightly rapid. Purple fine vein in tiger's mouth penetrating three palaces. Black dry tongue. Grandmother instructed mother to open prescription, but encountered vomiting with every medicine or food. Fasting for one month. I asked: How alive without eating? Answer: Sees bowl, desires drink. Drinking causes diarrhea. Thought medicines like tea/water would not cause vomiting. Because illness long depletes Qi, used Yanyan (Swallow's Nest) one tael to replace Yuan Shen and Maidong; Lingjiao (Antelope Horn), Zhuye (Bamboo Leaf) to replace Chuanlian; Hei Ludou Pi (Black Soybean Skin) one tael to replace Dihuang; Fuling (Poria), Tongcao (Tetrapanax Pith) to promote urination. All odorless substances. Drank freely for three days. Tongue turned from black to yellow, urination通畅, diarrhea improved. Another three days, fully recovered, ate porridge and rice, still holding grandchildren today.
Bro-in-law Feng Puyuan from Shuigouying. February, among various offices. Fever, cough, wheezing, illness like latent cold. Caught wind and rain on the road. Arrived home, all sinews and collaterals pulling in pain, hematemesis (loss of red/blood). Pulse wiry and rapid, thin yellow tongue coating. Lung Wei and Heart Ying both affected. Ying is heavier than Wei, must treat bleeding first. Used Genshengdi (Rehmannia Root) one tael, Maidong (Ophiopogon Tuber), Yinhua (Honeysuckle Flower), Lingjiao (Antelope Horn), Shanchahua (Camellia Flower), Sigualuo (Luffa Sponge), Yuan Shen (Polygala Root), Chishao (Red Peony Root), Danpi (Moutan Cortex), Sangye (Mulberry Leaf). Two doses: bleeding stopped. Then used cooling to resolve Wei-level Wind-Heat. Body cooled, recovered.
November of Yichou year. Zhu Shiweng, aged seventy-three. Fever, cough, severe left hypochondriac pain. Pulse wiry on left, especially wiry and large on right. Said this is Fengwen with Liver involvement, fearing hematemesis. Next day: indeed bled. Used Weirui Tang minus Mahuang (Ephedra Herb) and Shigao (Gypsum Fibrosum), added Lingjiao (Antelope Horn), Danpi (Moutan Cortex), Sangye (Mulberry Leaf), Yuan Shen (Polygala Root), Maidong (Ophiopogon Tuber), then Osmu (Oyster Shell), Chaihu Shao (Bupleurum Root Tip), Biejia (Tartare Testudinis Carapax), Jiangxiang (Dalbergia Odorifera Lignum), Suzi (Perilla Fruit), Chishao (Red Peony Root). Also instructed to use Ou Zhi (Lotus Root Juice) and Zhégānzhī (Sugarcane Juice) instead of tea/water. Nourishment led to recovery.###Re Ru Xue Shi (Heat Entering the Blood Chamber)###
June of Gengxu year during Daoguang reign. Wife of Wang Yuantong from Shuicheng Alley. Ill with Wenxie for six or seven days, menstruation arrived. I congratulated her, using previous methods. Family members knowledgeable in medicine said promoting menstruation requires warm herbs. Changed to Paojiang (Roasted Ginger), Honghua (Carthamus Flower) etc. Menstruation stopped. Screaming, throwing things, irritability. Died overnight.