刘泰来年三十二岁。体丰面白。夏月惯用冷水灌汗。坐卧巷曲当风。新秋病疟三五发。后用药截住。遂
觉胸腹间胀满日增。不旬日外。腹大胸高。上气喘急。二便全无。饮食不入。能坐不能卧。能俯不能仰。势颇
危急。虽延余至家。其专主者在他医也。其医以二便不通。服下药不应。商用大黄二两。作一剂。病
者曰。不如此不能救急。可速煎之。余骇曰。此名何病也。而敢放胆杀人耶。医曰。伤寒肠结。下而不通。
惟有大下一法。何谓放胆。余曰。世间有不发热之伤寒乎。伤寒病因发热。故津液枯
槁。肠胃干结。而可用下药以开其结。然有不转失气者不可攻之戒。正恐误治太阴经之腹胀也。此病因腹中
之气。散乱不收。故津水随气横决四溢而作胀。全是太阴脾气不能统摄所致。一
散一结。相去天渊。再用大黄猛剂大散其气。若不胀死。定须腹
破。曷不留此一命。必欲杀之为快耶。医唯唯曰。吾见不到。姑已之。出语家人曰。吾去矣。此人书多口溜。
不能与争也。病家以余逐其医而含怒。私谓医虽去。药则存。且服其药。请来未
迟。才取药进房。余从后追至。掷之沟中。病者殊错愕。而婉其辞曰。此药果不当服。亦未可知。但再有
何法。可以救我。其二弟之不平。则征色而且发声矣。余即以一柬。面辨数十条。而定
理中汤一方于后。病者见之曰。议论反复精透。但参术助胀。安敢轻用。大黄药已吃过二剂。尚未见行。不若
今日且不服药。挨至明日。再看光景。亦无可奈何之辞也。余曰。何待明日。腹中
真气渐散。今晚子丑二时。阴阳交剥之界。必大汗晕眩。难为力矣。病者曰。锉好一剂。俟半夜果有此证。
即刻服下何如。不识此时。尚可及否。余曰。既畏吾药如虎。煎好备急亦通。余就客寝。坐待室中呼召。绝
无动静。次早其子出云。昨晚果然出汗发晕。忙服尊剂。亦不见效。但略睡片时。仍旧作胀。进诊。病者
曰。服药后。喜疾势不增。略觉减可。且再服一剂。未必大害。余遂以三剂药料作一剂。加人参至三钱。服过又
进一大剂。少加黄连在内。病者扶身出厅云。内胀大减。即不用大黄亦可耐。但连日未得食。必用大黄些些。
略通大便。吾即放心进食矣。余曰。如此争辩。还认作伤寒病。不肯进食。其实吃饭吃肉。亦无
不可。于是以老米煮清汤饮之。不敢吞粒。余许以次日一剂。立通大便。病者始快。其二弟亦快云。定然
必用大黄。但前后不同耳。次日。戚友俱至。病者出厅问药。余曰。腹中原是大黄推荡之泄粪。其所以不
出者。以膀胱胀大。腹内难容。将大肠撑紧。任凭极力努挣。无隙可出。看吾以药通膀胱之气。不治大便。而
大便自至。足为证验。于是以五苓散本方与服。药才入喉。病者即索秽桶。小便先出。大便随之。顷刻泄下
半桶。观者动色。竞称华佗再出。然亦非心服也。一月后。小患伤风。取药四剂。与
荤酒杂投。及伤风未止。并谓治胀亦属偶然。竟没其功。然余但
恨不能分身剖心。指引迷津耳。实无居功之意也。
胡卣臣先生曰。世间不少血性男子。然肝脑无补者多矣。此段转移。全在危疑关头着力。所以为超。
Liu Tailai, aged thirty-two. His physique was robust and his complexion pale. In summer, he was accustomed to pouring cold water over his sweat. When sitting or lying down, he would position himself in the crooked alleys, directly facing the wind. In early autumn, he contracted malaria, which occurred three to five times. Subsequently, medication was used to forcibly arrest the malaria attacks. Consequently, he felt increasing distension in the chest and abdomen. Within ten days, his abdomen became enlarged and his chest elevated; he suffered from shortness of breath and rapid breathing, complete obstruction of urination and defecation, inability to eat or drink, could only sit but not lie down, and could bend forward but not lean back. The condition was quite critical. Although I was invited to his home, the decision-making authority lay with another physician. This physician, due to the obstruction of urination and defecation, found that purgative medicines were ineffective, and thus prescribed two taels of Da Huang (Rhei Radix et Rhizoma) as a single dose. The patient said, "Without this, emergency relief is impossible; please decoct it quickly." I was horrified and asked, "What disease is this, that one dares to recklessly kill?" The physician replied, "This is Changbai (Cold Damage) causing intestinal binding (intestinal obstruction). Since downward methods fail, only the purgative method remains. What do you mean by 'reckless'?" I said, "Is there any Changbai without fever? The etiology of Changbai involves fever, which leads to the exhaustion of body fluids and dryness/binding of the intestines and stomach; thus, purgatives can be used to open the binding. However, there is a warning: if there is no passage of flatus (Zhuan Shi Qi), attack is contraindicated. This is precisely to prevent misdiagnosis of abdominal distension caused by Taiyin Meridian pathology. This patient's illness stems from the scattering and loss of control of Qi in the abdomen, causing body fluids to surge wildly and cause distension. It is entirely due to the failure of Taiyin Spleen Qi to govern and contain. One is scattering, the other is binding; they differ by heaven and earth. Using a strong dose of Da Huang to further scatter the Qi will either lead to death from distension or rupture of the abdomen. Why not spare this life? Must you kill him for satisfaction?" The physician nodded submissively and said, "I did not see this point. Let us stop for now." He then went out and told his family, "I am leaving. This man reads widely and speaks fluently; I cannot argue with him." The patient's family, angry at me for dismissing their doctor, privately told the physician, "Although the doctor has left, the medicine remains. Take the medicine, and invite [Yu Chang] later; it is not too late." As they took the medicine into the room, I chased after them from behind and threw the medicine into the ditch. The patient was utterly bewildered and spoke tactfully, "It is possible that this medicine was indeed inappropriate. But what other method can save me?" The patient's second brother showed displeasure on his face and raised his voice. I immediately wrote a letter, explaining dozens of points face-to-face, and prescribed Lizhong Tang (Regulate the Middle Decoction) at the end. The patient read it and said, "The arguments are thorough and penetrating. However, Ren Shen (Ginseng Root) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) may aggravate distension. How dare I use them lightly? I have already taken two doses of Da Huang without seeing any evacuation. It is better not to take medicine today and wait until tomorrow to see the situation." This was also a statement of helplessness. I said, "Why wait until tomorrow? The True Qi in the abdomen is gradually dissipating. Tonight, during the Zi (11 PM-1 AM) and Chou (1 AM-3 AM) hours, which mark the boundary of Yin-Yang interaction and depletion, he will surely suffer from profuse sweating and dizziness, making treatment difficult." The patient said, "Decoct a dose. If these symptoms occur exactly at midnight, shall we administer it immediately? Do you think it is still timely?" I said, "Since you fear my medicine like a tiger, decocting it and keeping it ready for emergency use is acceptable." I stayed in the guest room, sitting in the chamber waiting for summons. There was absolutely no movement. The next morning, his son came out and said, "Last night, he indeed sweated and felt dizzy. We hurriedly administered your prescription, but it was ineffective. After sleeping briefly, the distension returned." I entered to examine him. The patient said, "After taking the medicine, I am pleased that the disease did not worsen and feels slightly relieved. Please give another dose; it is unlikely to cause great harm." I therefore combined three doses' worth of herbs into one, added Ren Shen (Ginseng Root) up to three qian, and administered it. Then, a larger dose was given, with a small amount of Huang Lian (Coptidis Rhizoma) added. The patient supported himself and walked out to the hall, saying, "Internal distension has decreased significantly. Even without Da Huang, I can endure it. However, having eaten nothing for days, I must use a little Da Huang to slightly promote bowel movement, so that I can eat with peace of mind." I said, "Arguing like this, you still consider it Changbai disease and refuse to eat. Actually, eating rice and meat is perfectly fine." Thus, he drank clear soup made from old rice, afraid to swallow even a grain. I promised a dose the next day to immediately promote bowel movement. Only then did the patient feel relieved. His second brother also rejoiced, saying, "Da Huang is definitely necessary, just different in timing." The next day, relatives and friends all arrived. The patient came out to the hall to ask about the medicine. I said, "The feces in the abdomen were originally pushed out by the purging action of Da Huang. The reason they did not exit is that the bladder was distended, making the abdominal cavity unable to accommodate it, thereby tightening the large intestine. No matter how hard he strained, there was no gap for exit. Watch me use medicine to unblock the Qi of the bladder. I do not treat the bowels directly, yet the stool will pass naturally. This serves as proof." Therefore, I gave him Wuling San (Five-Ingredient Powder with Poria) in its original formula. As soon as the medicine entered his throat, the patient demanded a bedpan. Urine flowed first, followed by stool, and half a bucket was evacuated in an instant. The observers were moved and changed expressions, competing to praise that Hua Tuo had reappeared. However, they did not truly believe in their hearts. A month later, he contracted a mild Wind-Cold. Four doses of medicine were taken, along with miscellaneous intake of meat and alcohol. As the Wind-Cold did not cease, they also considered the treatment of distension to be accidental, completely negating my merit. Yet, I only regret that I cannot split my body and cut open my heart to guide those lost in confusion. I truly have no intention of claiming credit.
Mr. Hu Youchen said: Among men of spirit and blood in the world, many lack nourishment for the Liver and Brain. This transformation relied entirely on exerting effort at the critical moment of danger and doubt. Hence, it stands out.