再者中医诊病，最要在于认证，一须认清是表证还是里证；二须认清是寒证还是热证；三须认清是虚证还是实证。认清了表证，还须辨出是经是络；认清了里证，还须辨出是脏是腑。各证有各证的凭据，各各显露出来，除是外行，谁也隐瞒不过，再也不会弄错，所以甲乙两医，或是甲乙丙三医，说出的病名，虽或不同，而认出的病证，再无有不同的。
至于治法，或先治表，或先救里，或表里双解，或上下分消，看法似不齐一，其实如古名将之用兵器，如吕布用戟，关羽用刀，张飞用矛，赵云用枪，各擅其长，其杀敌则一也，去病则一也。中医之认病法，中医之治病法，断不能以西医眼光等量齐观也。
《寒窗医话》序埭溪张澹冲，从学有年，余之诲生徒也，只授仲景《伤寒论》一书，教之以读法，从有字处推之无字处，只许搜求证据，不尚空谈理论，凡六气胜复、五行生克、标本中见等说，概置高阁，暂不谈论，一扫前人论注恶习，虽未必推倒一时智勇，庶可许开拓万古心胸。张生埋头窗下，三易寒暑，风雨晦明，讨论无间，执经问难，颇能起子，此医话皆张生研究时所作也，虽立说未必同于前贤，或且攻击前贤，然为学之要，在以独得之见，勘出真理，固不必以前贤之说所囿也。上海国医学会征求医籍，澹冲即以此作应征，余嘉其年青而能用心，遵余之教而读书，故乐而为之序。
民国二十五年六月一日青浦陆士谔序于沪寓病家之心理医家与病家，为对待名词，然而医之为家，确然其难乎言之，吾业医，吾深知医之情状，深知医之品性，吾欲言医，吾不忍也。
医之中，有名医，有时医，有庸医，如何者是名医，如何者是时医，如何者是庸医，吾不难曲状其情态，绘形绘声，呼之欲出。既心有所不忍，只得借对待之病家，一写其心理。
病家者，有病之家也，有病而不自知，延医以求其知，有病而不自治，延医以求其治，然而延来医家，能否知病，能否治病，病家是否有辨别之能力。
病家心理，以为场面阔绰者，必是名医；风头健旺者，必是名医；功架十足者，必是名医；神气活现者，必是名医；应酬圆到者，必是名医，照此心理，悬格以求，南辕北辙矣。
延到病家，不待诊察手续之完毕，急急动问，所病何名?愈在何日?有无危险?在病家急于求知，急于求愈，原不足怪。而医者假使未必诊察，随口回答，在病家看来，以为此公不假思索，熟极而流，定是名医，而不知其随口乱道，出门不认货，全是胡诌也。真是名医，出言吐语，定然郑重，定然谨慎。病家而不辨此心理，虽遇名医不能识也，虽非名医必误认也。
诊病记[湿温出红疹重症]余记何莲根之诊，曾言寻常百姓家之病，虽重易治，富贵家之病，虽轻难疗，此是事实，并不是有激而言，最近又有高德兴一症，颇有一记之价值。
高德兴，绍兴人，一卖咸菜商也，住上海虹口临平路德润里34弄三号门牌。于二十五年六月二日，来寓就诊。身热已三日，胸闷肢酸，大便不行，自言回绍兴新婚，婚后来沪，途中冒风雨，衣履尽湿透，到沪后，奋勉营业，未得稍息，故患病十分沉重。余诊其脉数甚，舌苔色黄，告之日：“此湿温症，非寻常感冒可比，不能急愈。”为之立案曰：“湿遏热伏，胸闷身热，肢酸，脉数，舌苔黄，不大便，法与清热化湿。”方则：宋半夏三钱川连五分全瓜蒌三钱(打)焦枳实枳壳各八分陈皮二钱鲜菖蒲三钱竹二青三钱赤茯苓三钱六一散三钱(包煎)加鲜竹叶三钱枇杷叶三钱(去毛、包煎)服一剂，泄泻而胸闷如故，其家人持方来求减，乃去瓜蒌加猪苓三钱、泽泻三钱。
六月四日，二诊。身热较减，泄泻如故。案日：“湿热症，投小陷胸汤加味，热已减，泄泻口渴，舌苔黄，脉数，法与清热。”方则：黄芩三钱生白芍三钱川连五分生甘草七分白茯苓三钱车前子三钱(包)金银花三钱冬瓜皮三钱竹二青三钱加鲜竹叶三钱鲜芦根一尺(却节)服两剂。六月六日：三诊。病者遍身红疹透现矣。案曰：“湿热郁蒸募原，身热遍发红疹，口渴，舌苔灰，脉数，再与清热。”方则：连翘三钱金银花四钱黄芩三钱生白芍三钱天花粉三钱生甘草八分知母三钱赤茯苓三钱车前子三钱(包)加鲜竹叶四钱鲜茅根三扎(去心)鲜芦根一尺(去节)八日四诊。病者言昨日服药后，咳嗽，吐出鲜血一大口。余曰“此热伤血络也，无妨。”
案曰：“湿热症，胸闷口渴，身发红疹，咳血一口，舌苔灰腻，脉数，以前法治之。”方则：黄芩三钱生白芍三钱连翘三钱金银花四钱天花粉三钱，知母三钱鲜生地一两竹二青三钱丝瓜络三钱枇杷叶三钱(去毛，包)白薇钱半桑叶三钱鲜芦根一尺(去节)加鲜茅根三扎(去心)鲜竹叶四钱九日五诊。则胸次又闷，红疹白痦满布矣。案曰：“胸闷口渴，红疹白痦满布，脉弦数，法与气营两清。”方则：桑叶三钱牛蒡子三钱金银花四钱连翘三钱枇杷叶三钱(去毛、包)鲜竹叶三钱绿豆衣四钱天花粉四钱’知母三钱生山栀三钱淡豆豉三钱天麦冬各三钱加鲜茅根三扎(去心)鲜芦根一尺(去节)十一日六诊。案曰：“湿温症，遍发白痦，胸闷已减，脉缓，舌苔黄腻，法与清解。”方则：桑叶三钱光杏仁三钱枇杷叶三钱(去毛，包)天麦冬各三钱知母三钱天花粉三钱绿豆衣四钱鲜竹叶三钱鲜芦根一尺(去节)加生谷芽三钱莲子芯五分十三日七诊。身热已退。案曰：“湿温遍发白痦，投清解，身热已退，舌苔糙，脉弱，法与和阴。”方则：北沙参三钱金石斛三钱天麦冬各三钱生白芍三钱生甘草三分小生地三钱生谷芽三钱丝瓜络三钱枇杷叶三钱(去毛，包)鲜芦根一尺(去节)十五日八诊。病者自言身体软弱已极。余曰“此病去元虚也，不必虑。”案曰：“湿温身热已瘥，便溲皆少，自汗，舌苔较润，脉弱，法与和阴。”方则：北沙参四钱金石斛四钱玄参三钱天麦冬各三钱小生地四钱炙鳖甲六钱生白芍三钱生甘草四分知母三钱天花粉三钱丝瓜络三钱白茯苓三钱加鲜蔗皮二节十八日九诊。精神已振，惟汗多耳，与以潜阳和阴之剂。此病初诊后见泄泻，四诊后见吐血，倘在富贵之家，定然归咎药误，改就他医，乃高德兴与何莲根同一境况，对于余之治法，深信不疑，故获此微效云。
[观何莲根与高德兴二湿温症，陆公开首即用黄芩、黄连之苦寒，校者以为不切，盖开首尽可用芳香化浊法，如藿香、佩兰、朴花、青蒿诸品。盖苦寒有遏湿之弊，若在湿家之湿热症则另议，其证必较湿温症尤重矣。校者注。]
Furthermore, in Traditional Chinese Medicine (TCM), the most crucial aspect of diagnosing disease lies in syndrome differentiation (Zheng). First, one must clearly distinguish between Exterior Syndrome (Biao Zheng) and Interior Syndrome (Li Zheng); second, between Cold Syndrome (Han Zheng) and Heat Syndrome (Re Zheng); third, between Deficiency Syndrome (Xu Zheng) and Excess Syndrome (Shi Zheng). Once the Exterior Syndrome is identified, it is necessary to further differentiate whether the pathology involves the Meridians (Jing) or the Collaterals (Luo). Once the Interior Syndrome is identified, it is necessary to differentiate whether the pathology involves the Zang Organs (Zang) or the Fu Organs (Fu). Each type of syndrome has its own specific indicators, which manifest distinctly. Unless one is an outsider, no condition can be concealed, nor will errors occur. Therefore, even if Doctor A and Doctor B, or Doctors A, B, and C, give different disease names, the syndromes they identify will invariably be the same.
Regarding treatment methods, some prioritize treating the Exterior, some prioritize rescuing the Interior, some employ simultaneous resolution of both Exterior and Interior, and some use separate elimination from above and below. Although these approaches may appear inconsistent, they are akin to ancient generals using weapons: Lu Bu used a halberd, Guan Yu used a blade, Zhang Fei used a spear, and Zhao Yun used a lance. Each excelled in their respective weapon, yet their objective of defeating the enemy—and thus eliminating disease—remained identical. The TCM approach to identifying diseases and treating them cannot be equated with Western medical perspectives.
Preface to *Hanchuang Yihua*: Mr. Zhang Danchong from Daixi studied under me for many years. In teaching my students, I only instructed them in Zhang Zhongjing’s *Treatise on Cold Pathogenic Diseases* (*Shanghan Lun*). I taught them how to read: inferring meaning from what is unwritten based on what is written; encouraging them to seek evidence rather than indulge in empty theoretical discussions. Concepts such as the victory and reversal of the Six Qi (Liu Qi), the generation and restriction of the Five Elements (Wu Xing), and the Standard, Central, and Revealed aspects (Biao Ben Zhong Jian) were set aside and not discussed temporarily. This swept away the bad habits of previous commentators. While this may not overturn the views of contemporary scholars, it may well open the minds of future generations. Student Zhang buried himself in study for three winters and summers, discussing tirelessly regardless of wind, rain, or darkness. Holding classics to ask questions, he was quite capable of inferring other cases from one example. These medical notes are the result of his research. Although his theories may differ from, or even attack, those of former sages, the essence of scholarship lies in using unique insights to uncover truth; one need not be confined by the words of predecessors. When the Shanghai National Medical Association solicited medical texts, Mr. Danchong submitted this work. I appreciated his diligence despite his youth and his adherence to my teachings, and thus gladly wrote this preface.
June 1, Republic of China Year 25 (1936). Lu Shie, Qingpu, Preface at his residence in Shanghai.
The psychology of the physician and the psychology of the patient are relative concepts. However, describing the "physician" is indeed difficult. I practice medicine and deeply understand the circumstances and character of physicians. I wish to speak about physicians, yet I find myself reluctant.
Among physicians, there are renowned doctors (Ming Yi), fashionable doctors (Shi Yi), and incompetent doctors (Yong Yi). It is not difficult for me to vividly describe the demeanor of each, making them seem lifelike. Yet, feeling reluctant to do so, I shall instead write about the psychology of the patient, the counterpart.
The term "patient's family" (Bing Jia) refers to a household where someone is ill. They are unaware of their illness and invite a doctor to diagnose it; they cannot cure themselves and invite a doctor to treat it. However, does the invited physician truly know the disease? Can they cure it? Does the patient have the ability to discern?
The patient's psychology assumes that those with lavish displays are renowned doctors; those with strong momentum are renowned doctors; those with imposing mannerisms are renowned doctors; those with lively spirits are renowned doctors; those who are smooth in social interactions are renowned doctors. Following this psychology leads one astray, like driving south while intending to go north.
When the physician arrives, the patient, impatient for the completion of the diagnostic procedures, eagerly asks: What is the name of the disease? When will I recover? Is there any danger? Given the patient's urgency to know and recover, this is understandable. If the physician, without proper diagnosis, answers casually, the patient perceives this lack of hesitation and fluency as a sign of a renowned doctor, unaware that the physician is merely speaking nonsense and might deny responsibility later. A true renowned physician speaks with gravity and caution. If patients fail to discern this psychological trap, they will fail to recognize a renowned doctor even when met, and will mistakenly identify an incompetent one.
Case Record [Severe Case of Damp-Heat Warmth with Red Rash]
In recording the case of He Lian Gen, I stated that illnesses among common people, though severe, are easier to treat, whereas illnesses among the wealthy, though mild, are harder to cure. This is a fact, not merely an expression of indignation. Recently, a case of Gao Dexing has arisen, which is worthy of record.
Gao Dexing, a native of Shaoxing, was a salted vegetable merchant residing at No. 3, Doorplate 34, Lane 3, Derun Li, Linping Road, Hongkou, Shanghai. He visited my residence on June 2, Republic of China Year 25. He had suffered from fever for three days, accompanied by chest tightness, limb soreness, and constipation. He reported returning to Shaoxing for his wedding, then coming to Shanghai. On the journey, he was caught in wind and rain, getting his clothes and shoes thoroughly wet. Upon arriving in Shanghai, he worked diligently without rest, leading to a severe illness. My pulse diagnosis revealed a rapid pulse (Shu Mai), and the tongue coating was yellow. I told him, "This is Damp-Heat Warmth (Shi Wen Bing), not comparable to a common cold; recovery will not be immediate."
Diagnosis: Dampness obstructing and Heat lurking within, causing chest tightness, fever, limb soreness, rapid pulse, yellow tongue coating, and constipation. Treatment principle: Clear Heat and transform Dampness.
Prescription: Ban Xia (Pinelliae Rhizoma) 3 qian, Huang Lian (Coptidis Rhizoma) 5 fen, Gua Lou (Trichosanthis Fructus) 3 qian (crushed), Jiao Zhi Shi (Immature Bitter Orange, fried) and Zhi Ke (Aurantii Fructus) 8 fen each, Chen Pi (Citri Reticulatae Pericarpium) 2 qian, Xin Chang Pu (Acori Tatarinowii Rhizoma) 3 qian, Zhu Er Qing 3 qian, Chi Fu Ling (Poria with Hostwood) 3 qian, Liu Yi San (Six-to-One Powder) 3 qian (wrapped for decoction), plus Xin Zhu Ye (Bambusae Folium) 3 qian, Pi Pa Ye (Loquat Leaf) 3 qian (de-haired, wrapped).
After one dose, diarrhea occurred, but chest tightness remained unchanged. The family brought the prescription requesting modifications. I removed Gua Lou and added Zhu Ling (Polyporus) 3 qian and Ze Xie (Alismatis Rhizoma) 3 qian.
June 4, Second Visit: Fever decreased slightly, diarrhea persisted. Diagnosis: Damp-Heat Disease. After administering Xiao Xian Xiong Tang (Minor Chest-Harmonizing Decoction) with modifications, heat reduced, but diarrhea and thirst continued. Tongue coating yellow, pulse rapid. Treatment principle: Clear Heat.
Prescription: Huang Qin (Scutellariae Radix) 3 qian, Sheng Bai Shao (Paeoniae Radix Alba) 3 qian, Chuan Lian Zi (Meliae Fructus) 5 fen (Note: Text says Chuan Lian, likely Huang Lian or Chuan Lian Zi, context suggests Huang Lian/Coptis for heat clearing, but text says 'Chuan Lian' again? Previous was 'Chuan Lian'. Assuming Huang Lian/Coptis based on context of clearing heat/dampness, or potentially Chuan Lian Zi. Given 'Chuan Lian' appeared before as Huang Lian alias or typo, I will stick to text literal 'Chuan Lian' but note standard is often Huang Lian here. Actually, looking at previous line 'Chuan Lian', it likely refers to Huang Lian. I will translate as Coptis Rhizoma/Huang Lian for consistency with therapeutic intent, or strictly 'Chuan Lian' if ambiguous. Let's assume Huang Lian based on 'Qing Re' goal.), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 7 fen, Bai Fu Ling (Poria) 3 qian, Che Qian Zi (Plantaginis Semen) 3 qian (wrapped), Jin Yin Hua (Lonicerae Japonicae Flos) 3 qian, Dong Gua Pi (Benincasae Exocarpium) 3 qian, Zhu Er Qing 3 qian, plus Xin Zhu Ye 3 qian, Xin Lu Gen (Phragmitis Rhizoma) 1 chi (nodes removed). Two doses administered.
June 6, Third Visit: The patient presented with widespread red rashes. Diagnosis: Damp-Heat stagnating and steaming the Semi-Interior (Mu Yuan), causing fever and widespread red rash, thirst, gray tongue coating, rapid pulse. Continue clearing Heat.
Prescription: Lian Qiao (Forsythiae Fructus) 3 qian, Jin Yin Hua 4 qian, Huang Qin 3 qian, Sheng Bai Shao 3 qian, Tian Hua Fen (Trichosanthis Radix) 3 qian, Sheng Gan Cao 8 fen, Zhi Mu (Anemarrhenae Rhizoma) 3 qian, Chi Fu Ling 3 qian, Che Qian Zi 3 qian (wrapped), plus Xin Zhu Ye 4 qian, Xin Mao Gen (Imperatae Rhizoma) 3 bundles (heart removed), Xin Lu Gen 1 chi (nodes removed).
Day 8, Fourth Visit: The patient reported coughing up a large mouthful of fresh blood after taking the previous medicine. I said, "This is Heat damaging the Blood vessels; it is not serious."
Diagnosis: Damp-Heat Disease, chest tightness, thirst, red rash on body, one mouthful of hemoptysis, gray greasy tongue coating, rapid pulse. Continue with previous treatment method.
Prescription: Huang Qin 3 qian, Sheng Bai Shao 3 qian, Lian Qiao 3 qian, Jin Yin Hua 4 qian, Tian Hua Fen 3 qian, Zhi Mu 3 qian, Xian Sheng Di (Rehmanniae Radix Recens) 1 liang, Zhu Er Qing 3 qian, Si Gua Luo (Luffae Fructus Retinervus) 3 qian, Pi Pa Ye 3 qian (de-haired, wrapped), Bai Wei (Cynanchi Atrati Radix) 0.5 qian, Sang Ye (Mori Folium) 3 qian, Xin Lu Gen 1 chi (nodes removed), plus Xin Mao Gen 3 bundles (heart removed), Xin Zhu Ye 4 qian.
Day 9, Fifth Visit: Chest tightness returned, and white papules (Mi Ren Zhen/Bai Wu) covered the body along with red rashes. Diagnosis: Chest tightness, thirst, widespread red rash and white papules, wiry-rapid pulse. Treatment principle: Simultaneously clear Qi and Ying (Nutrient) levels.
Prescription: Sang Ye 3 qian, Niu Bang Zi (Arctii Fructus) 3 qian, Jin Yin Hua 4 qian, Lian Qiao 3 qian, Pi Pa Ye 3 qian (de-haired, wrapped), Xin Zhu Ye 3 qian, Lv Dou Yi (Vigna Radiata Testa) 4 qian, Tian Hua Fen 4 qian, Zhi Mu 3 qian, Sheng Shan Zhi (Gardeniae Fructus) 3 qian, Dan Dou Chi (Sojae Semen Praeparatum) 3 qian, Tian Mai Dong (Ophiopogonis Radix) 3 qian each, plus Xin Mao Gen 3 bundles (heart removed), Xin Lu Gen 1 chi (nodes removed).
Day 11, Sixth Visit: Diagnosis: Damp-Heat Warmth, widespread white papules, chest tightness reduced, slow pulse, yellow greasy tongue coating. Treatment principle: Clear and resolve.
Prescription: Sang Ye 3 qian, Guang Xing Ren (Armeniacae Semen Amarum) 3 qian, Pi Pa Ye 3 qian (de-haired, wrapped), Tian Mai Dong 3 qian each, Zhi Mu 3 qian, Tian Hua Fen 3 qian, Lv Dou Yi 4 qian, Xin Zhu Ye 3 qian, Xin Lu Gen 1 chi (nodes removed), plus Sheng Gu Ya (Hordei Fructus Germinatus) 3 qian, Lian Zi Xin (Nelumbinis Plumula) 5 fen.
Day 13, Seventh Visit: Fever subsided. Diagnosis: Damp-Heat Warmth with widespread white papules, treated with clearing and resolving, fever gone, rough tongue coating, weak pulse. Treatment principle: Harmonize Yin.
Prescription: Bei Sha Shen (Glehniae Radix) 3 qian, Jin Shi Hu (Dendrobii Caulis) 3 qian, Tian Mai Dong 3 qian each, Sheng Bai Shao 3 qian, Sheng Gan Cao 3 fen, Xiao Sheng Di (Rehmanniae Radix) 3 qian, Sheng Gu Ya 3 qian, Si Gua Luo 3 qian, Pi Pa Ye 3 qian (de-haired, wrapped), Xin Lu Gen 1 chi (nodes removed).
Day 15, Eighth Visit: Patient reported extreme physical weakness. I said, "This is deficiency of Original Qi after the disease has passed; do not worry." Diagnosis: Damp-Heat Warmth, fever resolved, scanty urination and stool, spontaneous sweating, moister tongue coating, weak pulse. Treatment principle: Harmonize Yin.
Prescription: Bei Sha Shen 4 qian, Jin Shi Hu 4 qian, Xuan Shen (Scrophulariae Radix) 3 qian, Tian Mai Dong 3 qian each, Xiao Sheng Di 4 qian, Zhi Bie Jia (Testudinis Carapax et Plastrum, honey-fried) 6 qian, Sheng Bai Shao 3 qian, Sheng Gan Cao 4 fen, Zhi Mu 3 qian, Tian Hua Fen 3 qian, Si Gua Luo 3 qian, Bai Fu Ling 3 qian, plus Xian Zhe Pi (Sacchari Candis Cortex) 2 segments.
Day 18, Ninth Visit: Spirit revived, only excessive sweating remains. Prescribed a formula to anchor Yang and harmonize Yin.
In this case, diarrhea appeared after the first visit, and hemoptysis after the fourth. In a wealthy household, this would surely be blamed on medicinal error, leading to changing physicians. However, Gao Dexing, sharing the same situation as He Lian Gen, trusted my treatment method completely without doubt, hence achieving this slight efficacy.
[Commentary: Observing the two Damp-Heat Warmth cases of He Lian Gen and Gao Dexing, Dr. Lu initially used the bitter-cold herbs Huang Qin and Huang Lian. The editor considers this inappropriate. Initially, aromatic damp-resolving methods could have been used, such as Huo Xiang, Pei Lan, Pu Hua, Qing Hao, etc. Bitter-cold herbs have the drawback of obstructing Dampness. If it were a Dampness-family Damp-Heat disease, it would be discussed differently, as that condition would necessarily be more severe than Damp-Heat Warmth. Editor's Note.]