〔一〕医话不知始于何人。殆滥觞于诗话而有是目。余所见者。愿体医话友渔斋医话柳洲医话潜斋医话凡四
种。愿体医话中重载良方。惟前列医话十二则。故一名愿体医话良方。友渔斋医话则分一览延龄橘旁杂论上
池涓滴肘后偶钞证治指南药笼短剧为六种。柳洲医话乃王孟英辑魏柳洲玉横续名医类按中按语单方。为
柳洲医话。故一名柳洲医话。良方。潜斋医话则录简效方于前。载医话于后。故一名潜斋简效方。同一医话。其体
例不同有如是。余自已冠后。喜读医书。有所见闻。随手识之。间附以心得。以备他日之参考。然已遗失者多矣。戊
寅秋。杜门养 。因检旧笥。得若干条。命儿子录出成帙。重为芟润之。标其名为医话稿。盖话所见。话所闻。并话所
得。拉杂不分门类。亦全无体例也。称稿者。明非定本也。条首编以数目字者。欲教我者有可专指。且前条于理有
误。后条可纠正。于义未尽。可重申。有意同者。可参合。有引证者。可披寻。所以清眉目也。引用书有购求数年而始
得。有辗转借阅者。内有世少传本之书。均记作者姓氏年世。思存古书之名目也。先得二卷。友人姚静庵广文见
而韪之。以为可以问世。嘱乃弟秋岩付诸手民。余固辞不获。惟有道君子。指其谬疵。而进以高深。则幸甚。〔仲圭
按〕此条乃作者自叙。
〔二〕愿体医话曰。“今创一议。无论内外大小。一年之中。岂无一二奇证。若怀之胸臆。则近于秘道不传。若登之
枣梨。又碍于少难成帙。何不于三五知己中。每于岁底。各出所治奇病。观何证。服何药。如何疗。如何愈。共成一卷。
以为医按。多年增广。亦是不朽之举。庶使后人有迹可循。而无识认不真之憾矣。功不在卢扁下也。然近日又有
一种时弊。凡遇疾病危险。诸医会集。其中学术平常者。不过轻描淡写。而识见高明者。若欲另立意见。惟恐招人
妒忌。万一不效。又虑损名。瞻前顾后。亦是大同小异了事。殊不知上天赋我聪明才智。若临证之际。不费一番思
索。不用一番心血。代天宣化。救济苍生。只于此中求富贵。顾声名。以他人性命。痛痒无关。生死听天。清夜思之。
能无自愧。”按愿体医话一卷。扬州史 臣典所着。皆时医药石之言。多急救生全之法。孳孳为善。可谓无微不至。
陈文恭公谓“史君饱谙世故。曲体人情。其言质直而透切。智愚易晓。”偶录一则。蔼然仁者之言。切中时弊之
论。窥见一斑矣。
〔三〕柯韵伯先生“气上腾便是水”一语。最足玩味。盖阳气凝结。津液不得上升。以致枯燥。治宜温热助阳。俾
阴精上交阳位。如釜底加薪。釜中之水气上腾。而润泽有立至者。仲圣以八味肾气丸治消渴。亦此义。以肺为五
脏六腑之华盖。下有暖气上蒸。即润而不渴。若下虚极。则阳气不能升。故肺干而渴。譬如釜中有水。以板盖之。下
有火力。暖气上腾。而板能润。无火力。则水气不能上板。终不可得而润也。然枯燥由于阴竭者。则是泉源既竭。必
须大剂濡养频服。如救焚然。始克有济。同一枯燥证。有阴凝阴竭之分。二证霄壤悬殊。万一误投。死生立判。不可
不细审也。
〔四〕痰属湿。为津液所化。盖行则为液。聚则为痰。流则为津。止则为涎。其所以流行聚止者。皆气为之也。庞
安常有言。“人身无倒上之痰。天下无逆流之水。故善治痰者。不治痰而治气。气顺。则一身之津液亦随气而顺矣。”
余谓“不治痰而治气”一语。为治痰妙谛。盖痰之患由于液不化。液之结由于气不化。气之为病不一。故痰之
为病亦不一。必本其所因之气。而后可治其所结之痰。医旨绪余曰。“治痰当察其源。”倘以二陈统治诸痰。因
于湿者固宜。使无湿则何以当之。如因于火。则当治火。火降金清。秋令乃行。水无壅遏。痰安从生。丹溪朱氏曰。“
黄芩治痰。假其下火。”正谓此也。余可类推。
〔五〕河间刘氏曰。“肠胃郁结。谷气内发而不能宣通于肠胃之外。故善噫而或下气也。”余谓噫与下气。即属
宣通。所以肝胃病往往得噫与下气稍瘥也。虽不能宣通于肠胃之外。而犹得宣通于肠胃之上下也。
〔六〕大黄同附桂用。是温下法。叶氏医按痢门。姚颐真用大剂肉苁蓉配姜附。是即温下法化为温滑法。泻心汤
姜连并用。是苦辛开降法。马元仪印机草中干姜同栝蒌用。是即苦辛开降法化为辛润开解法。栝蒌润燥开结。
荡热涤痰。为胸膈热郁之圣药。其性濡润。谓之滑肠则可。若代大黄作下药用则不可。吾乡章虚谷有蒌仁辨。言之甚详。
〔七〕余治一暑湿证。已热退神清。胃动进食矣。忽急柬邀诊。仍发热神昏。更加气喘。细询因吃粥油三四盏。遂
致此。余力辞。病竟不起。阅本草纲目拾遗言。“粥油能实毛窍。滋阴之功胜熟地。”暑湿初愈服此。安得不复发而
增剧耶。又袁了凡先生曰。“煮粥饭。中有浓汁滚作一团者。此米之精液。食之最能补精。”又紫竹林单方治精
清不孕方。用粥油。日日取起。加炼过盐少许。空心服下。其精自浓。
〔八〕人知息道从口鼻出入。不知遍身毛窍。俱暗随呼吸之气以为鼓伏。所以外感表实证。毛窍阻而气机不能
相引。则发喘。内伤表虚证。汗多亡阳。毛窍开而气机过泄。则息微。
〔九〕洄溪徐氏谓天士叶氏。每以络字欺人。其实徐氏躯壳脏腑经络论有云。“人有皮肉筋骨。所谓躯壳也。而
虚其中。则有脏腑以实之。其连续贯通者。则有经有络。贯乎脏腑之内。运乎躯壳之中。为之道路。以传变周流者
也。”是明知有络。而每诋之。何也。或云。徐批叶案非真本。乃托名者。
〔十〕朴硝火硝咸名硝石。咸生卤地。假水火二大以为形质。朴硝属水。味咸气寒。性下走。故能推荡肠胃积滞。
折治三焦邪火。火硝属火。味辛带苦微咸。而气大温。性上升。故能破积散坚。治诸热病。升散三焦火郁。朴硝治热之
结。火硝治热之郁。一就下。一达上也。火硝投之火中则焰生。朴硝则否。其性从可知矣。紫雪丹中二硝并用。是热
郁欲其达。热结欲其降也。濒湖李氏曰。“火硝与硫黄同用。则配类二气。均调阴阳。有升降水火之功。治冷热缓
急之病。 制礞石。则除积滞痰饮。”盖硫暖而利。其性下行。火硝暖而散。其性上行。礞石之性寒而下。火硝之性
暖而上。一升一降。一阴一阳。此制方之妙也。奈汪 庵医方集解中礞石滚痰丸。误以朴硝制礞石。药肆不察。竟
遵其法。盖同名硝石。汪氏不及详考。而一字之讹。药性顿异。大背古人立方之意矣。用辨明之。
〔十一〕世间真虚损少。假虚损多。自患虚损者少。做成虚损者多。歙南吴师朗有鉴于此。着不居集一书。取易传
“变动不居”之义而名其书也。书分上下二集。上集内损。以阴阳五脏内亏立论。下集外损。以六淫外入。似损
非损立论。盖缘内外不分。真假莫辨。印定滋阴降火之一法。以治无定万变之病情。不虚而做成虚。不损而做成
损。良可浩叹。是书纠缪绳愆。独开生面。厥功岂不伟哉。惜其论治立方。铺排门面。无甚精义可咀嚼。窃恐仿其法
而施治。未必的有效验。然能唤醒病家医家。俾共知有外损之一途。不徒从事于蛮补。由是深思其故。神而明之。
则此书安可不读。（师朗名澄。其自序在乾隆四年。刊书在道光十五年。）〔仲圭按〕虚损之范围甚广。近世流行之肺劳遗
精等病。殆亦虚损之属。治肺劳以十药神书为最佳。而保真保和二汤尤妥。治久遗则林屋山人之加减地黄汤。亦平正可
法。
〔十二〕洄溪医案治毛姓痰喘。乃上实下虚证。用清肺消痰饮。以人参一钱。切小块送下。二剂而愈。毛曰。“徐君
学术固深。但人参切块之法。此聪明人以之炫奇耳。”后病复作。照前方加人参入煎。而喘愈甚。复延徐。谓“服
旧方而病有加。”徐曰。“得非人参与药同煎耶。”曰“然。”曰“宜其增病也。”仍以参作块服之。亦二剂而
愈。盖下虚固当补。但痰火在上。补必增剧。惟作块后入。则参性未发。而清肺之药已得力。迨过腹中。而参性始发。
已达下焦。方有益而无害也。此等治法。古人有行之者。特不察耳。按清肺消痰饮加人参。方也。参切块吞下。法也。
古人有方必有法。如桂枝汤服已。须啜热稀粥。以助药力而取汗。附子泻心汤。附子用煎。三味用泡。扶阳欲其熟
而性重。开痞欲其生而性轻。若此之类。不胜枚举。其方其法。丝丝入蔻。细心体会。妙义始见。族侄柏堂谓余言。二
十一岁时。酒后寐中受风。遍身肌肤麻痹。搔之不知痛痒。饮食如常时。淮阴吴鞠通适寓伊芳家。请诊。吴用桂枝汤。
桂枝五钱。白芍四钱。甘草三钱。生姜三片。大枣两枚。水三杯。煮二杯。先服一杯。得汗止后服。不汗再服。并属弗
夜膳。临睡腹觉饥。服药一杯。须臾啜热稀粥一碗。覆被取汗。柏堂如其法。只一服。便由头面至足。遍身 得微汗。
汗到处以手搔之。辄知痛痒。次日病若失。此用古方古法也。假令此证知用桂枝汤。而不知啜热稀粥。恐未必得
汗。即使稍有汗。去病岂能若是之尽且速耶。
〔十三〕慎斋遗书曰。“一妇泄泻。两尺无神。此肾燥不合也。医用茯苓益智仁即发晕。因用肉苁蓉三钱以润之。
五味子八分以固之。人参一钱以益其气。归身八分以养其血。白芍甘草以和其中。炮姜二分以安其肾。二帖效。
十帖愈。丸即前方加倍。蜜丸。”张东扶曰。“余因慎斋‘肾燥不合’之语。因思精滑一证。理亦同情。盖肾属水。
水亏则燥。水燥则无以养肝。木无水养。则燥而生火。肾既失其封蛰之职。不合而开。肝遂恣其疏泄之性。因开而
泄。愈泄则愈燥。愈燥则愈开。此时徒清火。徒兜涩。无益也。必用润药润其肾。则燥而不合者可以复合。而且肝得
所养。火亦不炽。何致疏泄之性。一往不返哉。立方之法。润肾为君。而兼用清肺补肝之品。”按“肾燥不合”一语。
未经人道。似奇创。然具有至理。凡物润则坚密无缝。燥则绽裂有痕。肾开窍于二阴。肾耗而燥。其窍开而不合矣。
〔十四〕疟证以日作者轻。间日者重。此不可拘。若日作而寒热之时短。其势又不甚。则诚轻。倘势盛而时又长。
反不如间日者尚有休息之一日也。胡可云轻。又疟发渐早为易痊。渐晏为未止。亦不可拘。如发渐早而热退之时
照旧。则其寒热加长矣。愈长则正气愈虚而加剧。如发渐迟而热退之时照旧。则其寒热渐短矣。短则邪气愈衰
而自止。又夜疟皆云邪入血分。当用血药。以提其邪。说固可通。景岳归柴饮。鼓峰香红饮。二方俱佳。然初起在夜。
嗣后不早不晏。始终发于夜者是也。设趱前渐近日昃。缩后已至日出。皆不得谓之夜疟矣。此古今医案按中语
也。此语亦未经人道。古今医案按。嘉善俞东扶震所着。嘉庆时人。
〔十五〕本草谓猪肉助火生痰。发风动气。于人有损无益。邹润安谓坎为豕。在地支则属亥。不但养胃。其补肾水
有专能。本草损人之说。汪 庵亦不以为然。惟脾虚湿盛之人。有酿痰滑泻之弊。时疫流行之际。有壅浊召疾之
虞耳。制为兰薰。俗呼火腿。补虚开胃。病后最宜。按古人以猪肉作药物者不多见。续名医类案中一则。特录出。汪
赤治张姓夏月途行受暑。医药半月。水浆不入。大便不通。唇焦舌黑。骨立皮干。目合肢冷。诊脉模糊。此因邪热
熏灼。津血已枯。形肉已脱。亡可立待。若仅以草木根皮。滋养气血。何能速生。嘱市猪肉四两。粳米三合。用汁一碗。
又梨汁一杯。蜜半杯。与米肉汁和匀。一昼夜呷尽。目微开。手足微动。喉间微作呻吟。如是者三日。唇舌转润。退去
黑壳一层。始开目能言。是夜下燥屎。脉稍应指。再与养阴。匝月而愈。（温热经纬言。温疫证邪火已衰。津不能回者。
宜用鲜猪肉数斤。切大块。急火煮清汤。吹净浮油。恣意凉饮。乃急救津液之无上妙品。按此法必须用在邪火已衰之后。）
因忆族兄云涛病痰饮气喘。身躯肥胖。行不数武。辄喘甚。因偕同志聘吴鞠通来绍。时道光乙酉也。吴以大剂石膏半夏
等。治之数月。喘渐平。痰亦少。身躯顿瘦。愈后即登高亦不作喘。案载吴氏医案中。鞠通归淮阴。濒行时。嘱弗食猪
肉。后偶食之。即觉痰多。身躯复骤胖。嗣后终身不敢食猪肉。此痰湿证忌食猪肉之一征也。又失音证忌食火腿及皮蛋。
余亲见患失音人食二物增剧。
〔十六〕营卫之气。出入脏腑。流布经络。本生于谷。复消磨其谷。营卫非谷不能充。谷非营卫不能化。是营卫者。
生身之大关键。不特营卫自病当注意。即脏腑有病。亦当顾及营卫也。内经谓“五脏之道皆出于经隧。以行血气。
血气不和。百病乃生。是故守经隧焉。”夫所谓经隧者。非营卫所行之道路乎。出于经隧。以行血气者。是由内而
外行于营卫。血气不和。百病乃生者。是由内而外行之血气。或行之不及。或行之太过。或偏于营。或偏于卫。皆为
[1] It is unknown when or by whom the genre of "Yihua" (Medical Conversations/Notes) originated. It likely evolved from "Shihua" (Poetry Notes). The ones I have seen include *Yuanti Yihua*, *Youyuzhai Yihua*, *Liuzhou Yihua*, and *Qianzhai Yihua*, totaling four types. *Yuanti Yihua* heavily records excellent prescriptions, but lists only twelve medical cases at the beginning; thus it is also known as *Yuanti Yihua Liangfang* (Excellent Prescriptions of Yuanti Medical Notes). *Youyuzhai Yihua* is divided into six parts: *Yilan*, *Yanling*, *Jupang Zalan*, *Shangchi Juandi*, *Zhouhou Ouchao*, *Zhengzhi Zhinan*, and *Yaolong Duanju*. *Liuzhou Yihua* was compiled by Wang Mengying from the annotations and single prescriptions in Wei Liuzhou's *Yuheng Xu Mingyi Lei An* (Continuation of Classified Cases of Famous Physicians based on Yuheng), forming *Liuzhou Yihua*; hence it is also called *Liuzhou Yihua Liangfang*. *Qianzhai Yihua* records simple effective formulas first and medical notes later, so it is also named *Qianzhai Jianxiaofang* (Simple Effective Formulas of Qianzhai). The same genre, "Yihua," has such different formats. Since I added a preface to my own writings, I have enjoyed reading medical books. Whenever I had observations or insights, I recorded them casually, occasionally adding my personal reflections for future reference. However, many have been lost. In the autumn of the Wuyin year, while staying indoors for recuperation, I checked an old chest and found several entries. I ordered my son to transcribe them into a booklet and revised them again. I titled it *Yihua Gao* (Draft of Medical Conversations). It discusses what I have seen, heard, and learned, piled together杂乱ly without categorization or format. Calling it a "Gao" (Draft) indicates it is not a final version. Numbering the items at the beginning allows those who instruct me to refer specifically to them. If the logic of a previous item is wrong, the next can correct it; if the meaning is incomplete, it can be reiterated; if ideas are similar, they can be combined; if citations exist, they can be traced. This clarifies the structure. Some cited books were acquired after years of searching, others borrowed through intermediaries, including rare editions. I recorded the authors' names and eras to preserve the titles of ancient texts. The first two volumes were completed. My friend Yao Jing'an Guangwen read them, approved, and suggested publication, asking his brother Qiuyan to entrust them to the printers. I declined firmly but could not prevail. I only hope that gentlemen of the Way will point out errors and flaws and guide me to higher depths, which would be a great fortune. [Note by Zhonggui: This section is the author's autobiography.]
[2] *Yuanti Yihua* states: "I propose a new idea. Regardless of internal or external medicine, major or minor conditions, surely there are one or two strange cases each year. If kept in mind, it borders on secret transmission; if published, it may be too brief to form a book. Why not suggest this among three or five close friends? At the end of each year, each presents the strange diseases they treated, observing the syndrome, the herbs taken, the treatment method, and the cure, compiling them into one volume as medical cases. Over years of expansion, this would be an immortal act, allowing future generations to follow the traces and avoiding regret over misidentification. The merit would rival Lu Bian (Bian Que). However, there is a current malpractice: whenever a disease is critical and doctors gather, those with average skills merely skim over it, while those with high insight, fearing jealousy if they propose different opinions, and worrying about damage to reputation if ineffective, look forward and backward, settling for similarities. They fail to realize that Heaven endowed us with wisdom. When treating patients, if we do not think deeply and expend effort to act as Heaven's agent to save lives, seeking only wealth and fame while disregarding others' suffering, listening to fate for life and death, how can we not feel ashamed upon midnight reflection?" Note: *Yuanti Yihua* is a volume by Shi Chendi of Yangzhou, containing contemporary medical advice, mostly emergency preservation methods, striving for good deeds meticulously. Chen Wengong commented: "Master Shi knows the world well and understands human nature; his words are plain yet penetrating, understandable to both wise and foolish." I excerpted one passage, showing the words of a benevolent person and a critique of current malpractices, offering a glimpse of the whole.
[3] Mr. Ke Yunbo's statement "When Qi ascends, it becomes Water" is most worthy of contemplation. This is because Yang Qi condenses, preventing Jin Ye (Body Fluids) from ascending, leading to dryness. Treatment should use warm/hot herbs to assist Yang, allowing Yin Essence to ascend to the Yang position, like adding firewood to the bottom of a pot; the water vapor rises, providing immediate moisture. Zhang Zhongjing used Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill) to treat Xiao Ke (Wasting-Thirst), following this principle. The Lung is the canopy of the five zang and six fu organs. With warm air steaming up from below, it remains moist and thirst-free. If the lower jiao is extremely deficient, Yang Qi cannot rise, causing lung dryness and thirst. It is like a pot with water covered by a board; with heat below, vapor rises and moistens the board; without heat, vapor cannot reach the board, remaining dry. However, if dryness is due to Yin exhaustion, the spring source is depleted. Large doses of nourishing herbs must be taken frequently, urgently like fighting a fire, to be effective. Although both are dryness syndromes, one is Yin stagnation and the other Yin exhaustion; they differ vastly. Misdiagnosis leads to immediate life or death consequences, so careful examination is essential.
[4] Tan (Phlegm) belongs to Shi (Dampness) and is transformed from Jin Ye. Flowing it is Ye (Fluids); gathering it is Tan; flowing it is Jin; stopping it is Xian (Saliva). Their movement or stasis is governed by Qi. Pang Anchang said: "There is no upward-flowing phlegm in the body, nor reverse-flowing water in the world. Therefore, skilled phlegm-treaters do not treat phlegm directly but treat Qi. When Qi is smooth, all body fluids follow Qi smoothly." I consider "treating Qi rather than Phlegm" the profound truth of phlegm treatment. Phlegm issues arise from fluids not transforming; fluid knotting arises from Qi not transforming. Qi causes various diseases, so Phlegm causes various diseases. One must address the Qi cause to treat the Phlegm knot. *Yizhi Xuyu* says: "Treat phlegm by investigating its source." Using Er Chen Tang for all phlegm is suitable only for damp-origin phlegm. If there is no dampness, what applies? If caused by Fire, treat the Fire. As Fire descends and Metal clears, Autumn energy acts, Water flows freely, and Phlegm has no origin. Zhu Danxi said: "Huang Qin (Scutellaria Root) treats phlegm by borrowing its ability to descend Fire." This is exactly what he meant. I can infer similarly.
[5] Liu Hejian said: "Intestinal and stomach stagnation causes Grain Qi to emerge internally but not circulate externally, leading to belching or passing gas." I believe belching and passing gas are forms of circulation/diffusion. Thus, Liver and Stomach diseases often improve slightly after belching or passing gas. Although not circulating outside the intestines/stomach, they still circulate above and below them.
[6] Da Huang (Rhubarb Root) used with Fu Zi (Aconite Root) and Gui Zhi (Cinnamon Twig) is the Warm-Purging Method. In Ye Tianshi's *Medical Cases*, under Dysentery, Yao Yizhen used large doses of Rou Cong Rong (Cistanche Stem) paired with Jiang (Ginger) and Fu Zi, which transforms Warm-Purging into Warm-Sliding Method. Xie Xin Tang uses Jiang and Lian together, representing the Bitter-Acrid Opening-Descending Method. Ma Yuanyi's *Yinji Cao* uses Gan Jiang (Dried Ginger) with Gua Lou (Trichosanthes Fruit), transforming Bitter-Acrid Opening-Descending into Acrid-Moistening Opening-Resolving Method. Gua Lou moistens dryness and resolves knots, clearing heat and washing away phlegm, a holy herb for chest-diaphragm heat stagnation. Its nature is moistening; calling it sliding-intestine is acceptable, but replacing Da Huang as a purgative is not. My fellow townsman Zhang Xugu wrote *Lou Ren Bian* (Discussion on Trichosanthes Seed), explaining in detail.
[7] I treated a case of Summer-Dampness where fever subsided, spirit cleared, and stomach activity returned with food intake. Suddenly, an urgent summons found him febrile, comatose, and panting. Inquiry revealed he ate three or four bowls of congee oil (rice gruel surface film), causing this. I declined treatment; the patient died. *Bencao Gangmu Shiyi* states: "Congee oil solidifies pores and nourishes Yin better than Shu Di Huang (Prepared Rehmannia Root)." Taking this after initial recovery of Summer-Dampness naturally causes relapse and aggravation. Yuan Liaofan said: "The thick liquid rolling into a ball in cooked congee is the essence of rice; eating it best tonifies Essence." Also, a single prescription from Purple Bamboo Grove for infertility due to thin semen uses congee oil, collected daily, mixed with refined salt, taken fasting to thicken semen.
[8] People know respiration enters/exits via mouth and nose, unaware that all body pores subtly rise and fall with respiratory Qi. Thus, in Exterior Excess patterns of External Contraction, blocked pores prevent Qi mechanism interaction, causing asthma. In Interior Deficiency Exterior Deficiency patterns, excessive sweating leads to Yang loss, open pores cause excessive Qi leakage, resulting in faint breathing.
[9] Xu Dachun (Xixi) claimed Ye Tianshi deceived people with the word "Luo" (Collaterals). Yet Xu himself wrote in *Quke Zangfu Jingluo Lun*: "Humans have skin, flesh, sinews, bones—the shell. Inside the hollow are Zang-Fu organs filling it. Connecting and penetrating are Jing (Channels) and Luo (Collaterals), running inside Zang-Fu and through the shell, serving as roads for transformation and circulation." He clearly knew of Collaterals yet disparaged them. Why? Some say Xu's commentary on Ye's cases is not authentic but pseudonymous.
[10] Pu Xiao (Raw Mirabilite) and Huo Xiao (Niter) are both named Xiao Shi (Niter). Both born in saline lands, formed by Water and Fire elements. Pu Xiao belongs to Water, salty/cold, descending nature, pushing intestinal stagnation and suppressing San Jiao pathogenic fire. Huo Xiao belongs to Fire, pungent/bitter/salty, hot nature, ascending, breaking accumulation, dispersing hardness, treating heat diseases, ascending/dispersing San Jiao fire stagnation. Pu Xiao treats Heat Knots; Huo Xiao treats Heat Stagnation; one goes down, one goes up. Huo Xiao ignites in fire; Pu Xiao does not, revealing their natures. Zi Xue Dan uses both Niter to resolve stagnation (ascending) and knots (descending). Li Shizhen said: "Huo Xiao with Sulfur combines two energies, balances Yin/Yang, regulates ascending/descending Water/Fire, treating cold/heat/rigid/soft diseases. Processing Meng Shi (Hydrocalcite) with Niter eliminates stagnation/phlegm-fluids." Sulfur is warm/advancing, descending; Huo Xiao is warm/dispersing, ascending; Meng Shi is cold/descending; Huo Xiao is warm/ascending. Ascend/Descend, Yin/Yang—this is the subtlety of formula making. Unfortunately, Wang Ang's *Yifang Jijie* mistakenly used Pu Xiao to process Meng Shi for Meng Shi Gun Tan Wan. Pharmacies followed suit. Due to the same name, Wang failed to verify carefully; a single character error changed drug properties, contradicting ancient intent. I clarify this.
[11] True deficiency consumptions are rare; fake ones are common. Few suffer true deficiency; many create it artificially. Wu Shilang of southern She County, seeing this, wrote *Buju Ji* (Collection of Non-Abiding), naming it after the *I Ching* concept "Change abides nowhere." Upper volume discusses Internal Consumption (Yin/Yang/Five Zang internal deficit); Lower volume discusses External Consumption (Six Evils invading, appearing as consumption but not truly so). Because internal/external are confused, true/false indistinguishable, sticking to one method of nourishing Yin/descending Fire to treat variable conditions creates non-deficiency into deficiency. This sigh-worthy error is corrected by this book, opening new paths. Its merit is great. However, its treatment/formulation rhetoric lacks deep substance. Mimicking it may lack efficacy. Yet, awakening patients/doctors to External Consumption, avoiding blind tonification, and reflecting deeply makes this book essential reading. (Shilang, name Cheng; preface 1739; published 1835.) [Note by Zhonggui: Consumption scope is broad; modern Pulmonary Tuberculosis/Spermatorrhea belong here. Best for Pulmonary TB: *Shiyao Shenshu*; Baozhen/Baohe Decoctions are good. For chronic spermatorrhea: Linwushanshan's Modified Dihuang Tang is standard.]
[12] Xuxi Medical Cases treated a surnamed Mao's Phlegm-Asthma, a Upper Excess/Lower Deficiency pattern, using Qingfei Xiaotan Yin. Ren Shen (Ginseng Root) 1 qian, cut small, swallowed. Cured in two doses. Mao said: "Dr. Xu's scholarship is deep, but cutting Ginseng is just a clever trick." Relapse occurred. Same formula, Ginseng decocted. Asthma worsened. Xu asked: "Did you decoct Ginseng?" Yes. "No wonder it worsened." Used cut Ginseng again. Cured in two doses. Lower deficiency needs tonification, but Phlegm-Fire above makes tonification aggravate. Cutting Ginseng delays its action; Lung-clearing herbs work first. By the time it passes the abdomen, Ginseng acts in the Lower Jiao, benefiting without harm. Ancients did this, unnoticed. Qingfei Xiaotan Yin + Ren Shen is the Formula; swallowing cut Ginseng is the Method. Ancients had formulas and methods. Guizhi Tang requires hot thin porridge after ingestion to aid potency and induce sweat. Fuzi Xiexin Tang decocts Fuzi but infuses other three; tonifying Yang needs cooked/heavy nature; resolving痞 (fullness) needs raw/light nature. Such examples are endless. Formulas and methods interlock; careful appreciation reveals profound meanings. Cousin Botang told me: At 21, wind struck during sleep after drinking. Body numb, insensitive to pain/itch, digestion normal. Wu Jutong of Huaiyin visited. Used Guizhi Tang: Guizhi 5 qian, Baishao 4 qian, Gancao 3 qian, Shengjiang 3 slices, Dazao 2 pieces. Water 3 cups, boil to 2 cups. Drink 1 cup first; stop if sweat; repeat if no sweat. Advised no dinner. Hungry before bed, drank 1 cup, then hot thin porridge, covered blanket for sweat. Botang followed. One dose induced slight sweat from head to feet. Scratching sweaty areas restored sensation. Next day, cured. This uses ancient formula/method. Without hot porridge, sweat might not occur; even if slight, cure wouldn't be so complete/fast.
[13] *Shenzhai Yishu* says: "A woman with diarrhea, empty Chi pulses, indicates Kidney Dryness mismatch. Doctor used Fuling (Poria) and Yizhiren (Bennet Seed), causing dizziness. Used Rongshen (Cistanche) 3 qian to moisten, Wuweizi (Schisandra) 0.8 fen to secure, Ren Shen 1 qian to boost Qi, Dangshen 0.8 fen to nourish Blood, Baishao/Gancao to harmonize Middle, Paojiang (Fried Ginger) 0.2 fen to calm Kidney. Two doses effective, ten doses cured. Pills double the dose, honey pills." Zhang Dongfu said: "Inspired by 'Kidney Dryness Mismatch,' I realized Spermatorrhea shares similar logic. Kidney is Water; Water deficit causes Dryness; Dry Water fails to nourish Liver; Wood without Water nourishment generates Fire. Kidney loses sealing function, opens instead of closing; Liver indulges draining nature, leaking more, drying more, opening more. Clearing Fire/astringing helps nothing. Must moisten Kidney to restore closure. Liver gets nourished, Fire subsides, preventing relentless draining. Formula: Moisten Kidney as Sovereign, accompany with Lung-clearing/Liver-tonifying herbs." Note: "Kidney Dryness Mismatch" is novel yet logical. Moist objects are tight/seamless; dry objects crack. Kidney opens to two yins; Kidney depletion/dryness causes opening/mismatch.
[14] Malaria daily onset is light, intermittent heavy—but don't rigidly apply. Daily with short fever/chills and mild severity is indeed light. Severe/long daily attacks are worse than intermittent which has rest days. How can severe be light? Early onset eases; late onset persists—don't rigidly apply. Early onset with same resolution time means longer chills/fever, worsening Qi deficiency. Late onset with same resolution means shorter chills/fever, weakening pathogen, self-resolving. Night malaria implies Pathogen in Blood level, use Blood herbs to lift pathogen. Reasonable. Jingyue's Guichai Yin and Gufeng's Xianghong Yin are good. But night malaria starts at night, stays at night. Advancing toward sunset or retreating to sunrise disqualifies it as night malaria. This is from *Gujin Yi An An* by Yu Dongfu Zhenso of Jiashan, Jiaqing era. Unheard-before wisdom.
[15] *Bencao* claims Pork aids Fire, generates Phlegm, triggers Wind/Qi, harmful. Zou Run'an says Kan trigram is Pig, Earthly Branch Hai; nourishes Stomach, uniquely tonifies Kidney Water. Wang Ang disagrees with *Bencao*'s harm view. Only for Spleen Deficiency/Damp Abundance (phlegm/diarrhea risk) or Epidemic times (turbidity/disease risk) is it problematic. Made into Ham (Lanxun), tonifies deficiency, opens appetite, suitable post-illness. Ancient use of Pork as medicine is rare. *Xu Mingyi Lei An* records one: Wang Chi treated Zhang, summer travel heatstroke, 15 days meds, unable to eat/drink, constipation, black lips/tongue, emaciated, cold limbs, faint pulse. Heat scorched fluids/blood, flesh gone, death imminent. Herbs slow. Bought 4 liang Pork, 3 he Rice, boiled to 1 bowl juice. Mixed with 1 cup Pear Juice, 0.5 cup Honey. Sip over 24 hours. Eyes opened slightly, limbs moved, groaned. After 3 days, lips/tongue moist, black crust shed, spoke. That night passed dry stool, pulse responded. Continued Yin-nourishing, cured in month. (*Wenre Jingwei* says for Post-Epidemic Heat decline with fluid failure, fresh Pork large chunks, quick boil clear soup, remove oil, drink cold freely—supreme fluid rescue. Must use after Heat declines.) Recalled cousin Yuntao with Phlegm-Fluid Asthma, obese, panting after few steps. Hired Wu Jutong in 1825. Wu used large Gaoshi (Gypsum), Banxia (Pinellia) etc., months to calm asthma/reduce phlegm, weight loss, climbed heights without panting. Before leaving Huaiyin, Wu forbade Pork. Ate once, phlegm increased, weight surged. Never ate Pork again. Sign of Phlegm-Damp contraindication. Hoarse voice contraindicates Ham/Preserved Egg; I saw aggravation.
[16] Ying (Nutritive) and Wei (Defensive) Qi enter/exit Zang-Fu, spread through Jing-Luo, born from Grain, digest Grain. Ying/Wei need Grain to fill; Grain needs Ying/Wei to transform. Thus, Ying/Wei are key to life. Not only treat Ying/Wei disease, but consider them in Zang-Fu disease. *Neijing* says: "Paths of Five Zang emerge from Jing-Tui (Vessels) to move Blood-Qi. Disharmony of Blood-Qi generates hundred diseases. Guard Jing-Tui." Jing-Tui are paths of Ying/Wei. Moving Blood-Qi from inside-out through Ying/Wei. Disharmony (too little/too much, biased Ying/Way) causes disease.