《旧德堂医案》
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《旧德堂医案》一卷，清云间李修之先生遣著也。其书中所记之案，上自公卿，下逮贩贾，所载多怪异之病，所用皆奇特之法，其及门诸子早己付刊，西秦田华臣先生序文亦云已有刻本。惟乃时家刻书籍印送新友，未易普及。海上中医杂志按期选载，阅者多以不得急窥全豹为憾。裘君吉生特将旧藏抄本刊行，以副同道先睹为快之望，亦即中医杂志社选载流传之意也。
《旧德堂医案》序
尝闻炎帝之泽，寿世而资生；尧舜之政，仁民而及物。利济天下，其揆一也。然爱民者以亲亲为先，寿世者以老老为务。元晏先生云：人受先人之体，有八尺之躯，不知医事，此游魂耳。虽有忠孝之心，慈惠之念，君父危困，赤子涂地，何以济之。圣贤所以精思极论，而尽其理耳。余尝有志于斯，奈周旋皇路，劳瘁簿书，每叹元晏高风，有惭苏仙奇行也。及承乏云门观风海邑有修之李君者，年富而学博，养邃而识纯。其决病也，如洞垣之照；其投剂也，若大还之丹。无论沉疴怪病，卒能返本回真，仁风翔洽遐声称久矣。余之所不能去于心者，辛丑季秋余将入觐彤廷。会家君患泄，神疲形瘁，已成痼疾，恐不起。其如会同大典，己任北山之后，报政长征，曷纾南顾之忧。自度此身不忠不孝，何自立于天地间也。幸李君以补天之功，斡旋造化，展指上阳春而沉寒忽散，泼壶中甘露而元气顿光；起家君于万死一生之危，依然堂上；俾不肖于燕山楚水之遥，还瞻膝下。微李君德泽不及此，余衔恩有素，铭德无涯，聊仿古人式庐下车之敬旌其堂曰：今日东垣以著培杏弘林步武乎易水师弟也。继而视膳失节，泄泻复作，病人膏盲，痛难身代，虽先子尽其天年，而李君德意之厚与道望之隆，深足追述也。孰谓和缓才名有逊秦晋两君哉！余故爰载始末附诸简端，以志感云。若夫活人功用，自有笔舌可纪。是刻，特其一班耳。西秦田元恺华臣氏书于云间署中
自 叙
纪古称湔浣肠胃，漱涤脏腑，割皮解肌，抉脉结筋，此炼精药形之术，超伦希世之神，其法不可考矣。三代以降汤液初兴，方论始备，十剂以准规矩，七方以明绳墨。补泻因乎虚实，寒热合乎时宜。症有真假，凭脉而施治；治分从逆，临症而审机。变化生克，若易道之无方；虚实奇正，如兵家之有纪。故一症有一定之论，一方有万变之能。未可寒热两歧，攻补互似也。非审脉验症辨明定治，何能斡旋造化之意耶。东坡云：脉症虽明，古今所患，至虚有盛候，大实有羸状，疑似之间，生死反掌。佩服斯言，战兢自惧，犹恐遗训在耳，贻羞地下。乃奋然鼓志，研求《灵素》考据百家，受知当世十有余年。虽无回生起死之功，稍有吹枯振槁之用。或舍症而取脉，或舍脉而取症，或对症以定方，或因方以立论。楮陈墨迹累案盈几矣，及门二三子请付剞劂，用广闻见。于是不揣愚鄙聊录一二，自知雕虫小技，不合大道。然而他山之石可以攻玉，狂夫之言圣人择也。则此刻或有道之所取裁乎。敢以就正。云间李修之甫识
小 叙
余读《史记》仓公治案，凡十有余人，历疏病状，备陈方论，未尝不叹功多也。盖人禀天地之大德，参精神之化机，有生必有病者，六淫与九气相干；有病必有治者，七方与十剂相济。故针灸砭石创制于千古，汤液醴酾垂训于万年，司命重权由来尚矣。第病有所因，人人自殊；症有传变，种种不一。始末变迁之异，寒热虚实之分，阴阳消长愈幻而愈化，攻补从逆愈出而愈奇。三指之下安危反掌，一匕之中生死攸关。必酝酿丹书，研精《灵素》，乃能入室升堂耳。惟吾师修之李夫子，天资颖悟，家学渊源，饮上池之水，洞隔垣之照；刀圭施而沉疴顿起，丹丸投而僵仆回生，九峰三泖咸化为寿城春台矣。翊也，企仰仪型，亲炙道范，幸大冶炉锤启小于聋喷，书绅明教盖已有年。二三同志虑照示之不广也，属余立案以记之。用是敢竭班见，敬陈片言。虽学海泓深，难以蠡测，龙门多士，何藉管窥。然山高在望，安敢怠荒，及论在兹，顾叨笔舌。即见闻所及，记述大概，上自名公巨卿，下逮贾夫牧竖，其间怪异之病，奇特之方，或还生起死，或养气守真。时而培补阳和；如阴霜见日；时而调元滋水，若甘露澍霖。圆融活泼，总不外回春之泽；临机应变，尽皆成利济之仁。庶天下后世，知吾师活人功用，上接乎仓公也。至若著述藏于金匮，编刻秘于玉函，上撷万卷之书，下振千秋之铎，此吾师入神之妙用。余未有知，安敢窥其万一耶。申江唐廷翊百拜书
申江邹邑侯子舍，仲夏患泻，精神疲惫，面目青黄，因素不服药，迁延季秋。忽眩晕仆地，四肢抽搦，口斜唇动，遍体冰冷，面黑肚缩，六脉全无。署中幕宾通晓医理，各言己见。或曰：诸风掉眩，法宜平肝。或曰；诸寒收引，理应发散。议论纷纭，不敢投剂。延予决之，曰：脾为升阳之职，胃为行气之府。坤土旺则清阳四布，乾健乖则浊阴蔽塞，此自然之理也。今泄泻既久，冲和耗散，所以脾元下脱，胃气上浮，阴阳阻绝，而成天地之否。故卒然仆倒，所谓土空则溃也。况肝脾二经为相胜之脏，脾虚则木旺，旺则风生，故体冷面青歪斜搐搦相因而致也。若误认风寒的候而用发表之方，恐已往之阳追之不返矣。宜急煎大剂参附庶为治本。合署惊讶见予议论严确，乃用人参一两熟附二钱生姜五片煎就灌下。一二时手指稍温，至夜半而身暖神苏，能进米饮，后以理中补中调理而安。
文学陆元振，经年伏枕，足膝枯细，耳轮焦薄，形容憔悴。历访名医俱用四物地黄汤，反觉胸膈凝滞，饮食减少，自谓此身永废而心犹未慊。延予商治，诊两寸关俱见沉滞，独尺部洪大，重按若绝，此肾虚精耗髓空骨痿之征也。盖肾者作强之官也，居下而主阴气，藏精而充骨髓者也。故肾旺则精盈，而肢节坚强；肾虚则髓竭，而膝膑软弱。王太仆云；滋苗者必固其根，伐下者必枯其上。今坎水不能灌溉经络，滋养百骸，宜乎耳轮焦薄，足膝枯细也。《内经》所谓肾气热则腰脊不举，足不任身，骨枯髓减，发为骨痿，端合此证。若徒事滋阴，恐用草木不能骤补精血，反壅滞阳气，以致中脘不舒。痿壁艰难耳，必用气血之属同类相求，兼以报使之品直抵下焦，譬之天雨沟渠盈溢滂沛河泽。奚虑隧道不行足膝难步耳。疏方：用人参白术当归地黄茯苓肉桂鹿茸龟甲萎蕤牛膝等，重剂，数帖而稍能转舒，百帖而愈。
嘉定孝廉陆佑公长子，童年发热，遍尝凉药，热势更炽，昼夜不减，复认阳明热证，投大剂白虎，禁绝谷食，致肌肉消瘦，渐致危困。迎予往治。见面色枯而不泽，脉现细数，力断大虚之证，速用甘温之药，庶可挽回。佑老骇曰；皆言外感寒热无间，内伤寒热不齐，今发热昼夜不已，而反言内虚者，必有确见，愿聆其详。予曰：阳虚昼剧√阴虚夜剧，此阴阳偏胜，因有界限之分。今脾胃并虚，阴阳俱病，元气衰残，阴火攻冲，独浮肌肤，表虽身热如焚，而寒必中伏。况肌肉消铄，脾元困惫也。彻夜无卧，胃气不和也。面无色泽，气血不荣也。脉象无神，天真衰弱也。此皆不足之明验。若禁用五味则胃气益孤，专服寒凉则生气绝灭。宜晨服补中益气汤加麦冬五味，以培资生之本，暮服逍遥散以疏乙木之郁，兼佐浓鲜之品苏胃养阴，庶元神充而虚阳内敛也。令先饮猪肺汤一碗，当即安睡，热即稍减，遂相信用药。服十剂而精神爽快，调理经年，眼参数斤，乃获全愈。
常镇道尊陈公，久患下血，甲辰春召予调治。诊得六脉安静，右尺重按稍虚，此命门火衰不能生土，土虚荣弱精微下陷而成便血之候。盖土为生化之母，堤防下气者，经曰：营出中焦，又曰，气因于中。中者脾胃也，为生气生血之乡，升清降浊之职。故胃盛则循经之血洒陈于外，脾强则守荣之血滋养于中，皆赖少火生气耳。若元阳既亏，离虚无以生坤，坎满无以养艮，使脾胃衰残而清阳不升，转输失化而阴血不统。宜乎精华之气不能上奉辛金，反下渗庚大肠也。当用甘温之剂培中宫之虚，升阳之品提下陷之气，庶生长令行而阴血归藏。方以补中益气加阿腰醋炒荆芥，数剂而安。
保定文选张鲁彦，少年登第，纵恣酒色，患便血四年，午晨各去一次。诸药杂投，剂多功少。延子调治，诊其脉象两手浮洪，断为肾虚火动之候。盖血乃精化，精充而血始盛；阴随阳动，阳密而阴乃固。房劳太过，则真水亏而虚火独发；元气不足，则闭藏弛而阴不固也。遂以熟地山萸山药石斛归身白芍秦艽阿醪等，煎成，调棉花子灰二钱，空心温服。数帖乃愈。
庠生陆符九夫人系董文敏公之孙女也。怀孕三月，忽崩涌如泉，胎坠而胞息，胀闷昏沉，发热谵语，上视见鬼，面黑流涎，已三日矣。此皆瘀血灌满胞中，上掩心肺，故恶证毕现。治法须分先后，用肉桂归尾泽兰香附红花牛膝元胡索，煎成调失笑散去其胞中垢秽，使不上升。继以参耆芎归肉桂助其传送，庶或有救。如方修服神思稍清，觉痛阵连腰，恍恍如下坠，将鹅翎探入喉中，一呕而胞下胀闷诸苦若失。
协镇王公生长蓟北，腠理闭密。癸卯秋谒提台梁公于茸城，乘凉蚤归中途浓睡，觉恶寒发热。缘素无病患，不谨调养，过食腥荤，日增喘促，气息声粗，不能安枕，更汗出津津，语言断落，不能发声。延予商治，六脉洪滑，右寸关尤汨汨动摇。以脉合证知为痰火内郁，风寒外束，正欲出而邪遏之，邪欲上而气逆之，邪正相搏，气凑于肺。俾橐龠之司失其治节，清肃之气变为扰动。是以呼吸升降不得宣通，气道奔迫发为肺鸣。一切见证咸为风邪有余，肺气壅塞之徵。若能散寒驱痰，诸病自愈。乃用三拗汤(三拗汤麻黄不去根节，杏仁不去皮尖，甘草生用。按此方治感冒风寒，咳嗽鼻塞。麻黄留节发中有收，杏仁留尖取其能发，留皮取其能涩，甘草生用补中有发，故名三拗)加橘红半夏前胡，一剂而吐痰喘缓，二剂而胸爽卧安。夫以王公之多欲，误认丹田气短，用温补之晶则胶固肤腠，客邪焉能宣越，顽痰何以涣解。故临症之时须贵乎谛审也。
献商吴维宗年将耳顺，忽然染吐血嗽痰，昼夜不安。医见年迈多劳，误投参耆。遂觉一线秽气直冲清道，如烟似雾，胸间隐隐而疼，喘急不卧。阖户悲泣，特遣伊侄远顾蓬门，具陈病概，并言伊子幼龄，倘成沉疴，何人抚育，深为惨恻。予悯其恳切，细为审度。知水干龙奋，焦灼娇脏，将见腐肺成痈，所以咳咯不止。盖金水一气，水火同原，乾金既可生水，坎水又能养金。惟源流相济则离焰无辉，如真水涸流则相火飞越。俾清虚廓然之质，成扰攘溷浊之气。况乎甘温助阳愈伤肺液，宜壮水之主以镇阳光，使子来救母而邪火顿息也。方以生熟地黄各二钱，天冬麦冬各一钱五分，茯苓紫菀川贝枯芩瓜蒌霜甘草节各一钱，二剂而烟消雾散，喘息卧安以后，加减不旬日而嗽痰俱止。
相国文湛持在左春坊时，患左足下有一线之火直冲会厌，燔灼咽嗌，必得抬肩数次，火气稍退，顷之复来，或用补中益气加肉桂服之更甚，求治于家君。脉两尺虚软，知非实火奔迫，乃虚炎泛上。然虚症之中又有脾肾之分，脾虚者气常下陷，法当升举，肾虚者气常上僭，又当补敛。今真阴衰耗，孤阳无依，须滋坎之阴，以抑离之亢，乃为正治。方以熟地四钱，丹皮山萸各二钱，麦冬钱半，五味三分，黄柏七分，牛膝一钱，煎成加童便一杯，服四帖而虚火乃退，左足遂凉。
参戎王丽堂夫佞佛长斋，性躁多怒，腹胀累年，历用汤丸全无奏效。延予治时，腹大脐突，青筋环现，两胁更甚。喘满难卧。此系怒气伤肝，坤宫受制之证。前医但知平肝之法，未知补肝之用，所以甲胆气衰，冲和暗捐，清阳不升，浊气不降，壅滞中州，胀势更增。殊不知肝木自甚则肝亦自伤，不但中土虚衰已也。法当调脾之中兼以疏肝之晶，使肝木调达则土自发育耳。拟方用苍术白术各钱半，白芍广皮香附茯苓各一钱，肉桂木香生姜皮各五分，服后顿觉腹响胀宽，喘平卧安，后加人参调理而全瘥。
休宁汪振先夫人，受孕八月，胎前劳瘵，肉削肌瘦，环口黧黑，舌色红润，饮食如常，六脉滑利，状若无病。予曰：九候虽调，形肉已脱，法在不治，所赖者胎元活泼，真阴未散；线息孤阳，依附丹田。譬之枯杨生花，根本已拨，胎前尚有生机，恐五十日后虽有神丹总难回挽。盖分娩之时，荣卫俱离，百节开张，况处久病之躯，当此痛苦之境，恐元神无依，阴阳决绝，仅陈躯壳，而生气杳然，岂能再延耶。越二月，果子存母殁。
*Old De Tang Medical Cases*
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*Old De Tang Medical Cases*, in one volume, was written by Mr. Li Xiuzhi of Yunjian (modern-day Songjiang, Shanghai) during the Qing Dynasty. The cases recorded in this book range from nobles and officials to common merchants. The diseases described are mostly strange and difficult ones, and the treatments used are all unique and effective. His disciples had already published it, and Mr. Tian Huachen from Xiqin (modern-day Shaanxi area) stated in his preface that printed editions were already circulating. However, at that time, various printing houses mainly produced books for gifting to new acquaintances, making widespread dissemination difficult. *Haishang Traditional Chinese Medicine Journal* selected and published excerpts periodically, but readers often regretted not being able to see the complete work quickly. Mr. Qiu Jisheng specially published an old handwritten copy he had collected, to satisfy the hope of colleagues to read it first, which also aligns with the intention of *Traditional Chinese Medicine Journal* to disseminate such works.
Preface to *Old De Tang Medical Cases*
I have heard that the grace of Yan Di (Shennong, the Divine Farmer) extends longevity and sustains life; the governance of Yao and Shun benevolently benefits the people and all things. The principle of benefiting the world is the same. However, loving the people prioritizes kinship, while sustaining life emphasizes respecting the elderly. Mr. Yuan Yan (Huangfu Mi) said: "Humans inherit their bodies from ancestors, possessing a body eight chi tall. If one does not understand medicine, this is merely a wandering soul. Even with a heart of loyalty and filial piety, and thoughts of kindness and compassion, when a ruler or father is in danger and distress, or infants lie in blood and dirt, how can they be saved?" Therefore, sages and worthies think deeply and argue extensively to exhaust the principles of medicine. I once aspired to this field, but unfortunately, I was busy with official duties, exhausted by paperwork, often sighing at the noble demeanor of Yuan Yan and feeling ashamed compared to the miraculous deeds of Su Xian (referring to ancient famous doctors like Dong Feng). When I served in Yunmen Guanfeng Haiyi (referring to my tenure in Songjiang), I met a man named Li Xiuzhi. He was young, vigorous, and erudite, with profound cultivation and pure insight. His diagnosis of diseases was clear as if seeing through walls; his prescription of medicines was miraculous like the Elixir of Life. Whether dealing with chronic or strange diseases, he could ultimately restore patients to their original state. His benevolent reputation has long spread far and wide. What I cannot forget is that in late autumn of the Xinchou year, I was about to enter the court to pay homage to the Emperor. At that time, my father suffered from diarrhea, with mental fatigue and physical emaciation, becoming a stubborn disease, fearing he might not survive. Just as the grand national ceremony approached, and after accepting appointment in Beishan, preparing for a long journey to report on governance, how could I ease my worries about my parents in the south? I felt that without loyalty and filial piety, how could I stand between heaven and earth? Fortunately, Mr. Li, with the merit of mending the sky, turned the course of nature. By applying the spring warmth of his fingers, the deep cold suddenly dispersed; by pouring the sweet dew from his pot, the primordial qi instantly recovered. He brought my father back from the brink of death, allowing him to remain alive in the hall; thus enabling me, though far away in Yanshan and Chu waters, to still gaze upon my parents' knees. Without Mr. Li's virtue and grace, I would never have received such care. I have always been grateful, and his virtue is boundless. I humbly imitate the ancients' respect shown by visiting thatched huts and lowering myself from the carriage, honoring his hall with the inscription: "Today's Dong Yuan [Li Dongyuan], promoting the Apricot Grove [medicine], following in the footsteps of the Yishui master-disciples [Zhang Zhongjing and Hua Tuo]." Later, due to irregular diet and lifestyle, the diarrhea recurred, the patient reached a critical stage, and the pain was unbearable. Although my father eventually lived out his natural lifespan, Mr. Li's profound kindness and high moral standing are deeply worthy of remembrance. Who says the fame of He Huan (Bian Que) is inferior to the two gentlemen of Qin and Jin! Therefore, I record the beginning and end and attach it to the front of the book to express my gratitude. As for the功 (merit) of saving lives, it is naturally recorded in words and writing. This edition is merely a glimpse. Written by Tian Yuankai Huachen in the Yunjian official residence.
Autobiographical Preface
Ancient texts mention washing the intestines and stomach, cleansing the viscera, cutting skin and muscles, separating tendons and binding vessels. These are techniques for refining essence and shaping the body, miracles surpassing ordinary standards and rare in the world, but their methods are now untraceable. After the Three Dynasties, decoctions (herbal soups) began to emerge, and formulas and theories became complete. The Ten Categories regulated rules, and the Seven Formulas clarified standards. Tonification and purging depend on deficiency and excess; cold and heat accord with seasonal appropriateness. Symptoms have truth and falsehood, treated based on pulse; treatment distinguishes compliance and opposition, examining opportunities according to symptoms. Changes and interactions resemble the formless way of the I Ching; deficiency, excess, odd, and regular tactics are like military discipline. Thus, each symptom has a fixed theory, and each formula has the ability to adapt to ten thousand changes. One cannot treat cold and heat dichotomously, nor confuse attacking and tonifying. Without carefully examining the pulse and symptoms to determine treatment, how can one manipulate the intentions of creation? Su Dongpo said: "Although pulse and symptoms are clear, the affliction of both ancient and modern times is that extreme deficiency may present with excess signs, and extreme excess may present with debility signs. Between similarity and difference, life and death turn in an instant." I admire these words, trembling with fear, lest I leave behind teachings only to bring shame underground. Thus, I roused my will, studied the *Ling Shu* and *Su Wen*, researched various schools, and was known by contemporaries for over ten years. Although I lack the power to revive the dead, I have some utility in reviving withered plants. Sometimes discarding symptoms to take the pulse, sometimes discarding the pulse to take symptoms, sometimes determining formulas based on symptoms, or establishing theories based on formulas. Paper and ink accumulated until desks were full. My disciples requested publication to broaden knowledge. Thus, not presuming my ignorance, I recorded a few cases, knowing these are minor skills unworthy of the Great Dao. However, stones from other hills may polish jade; even the words of a fool may be chosen by sages. Perhaps this edition may be taken as a reference by those who know the Way. I dare to seek correction. Li Xiuzhi, Yunjian, records this.
Minor Preface
I read the medical cases of Cang Gong in the *Records of the Grand Historian*. There were more than ten cases, detailing symptoms and presenting formulas and theories. I could not help but sigh at the multitude of merits. Humans receive the great virtue of heaven and earth, participating in the transformation of spirit and mind. Where there is life, there is disease, caused by the interference of the Six Evils and Nine Qi; where there is disease, there is treatment, aided by the Seven Formulas and Ten Categories. Thus, acupuncture, moxibustion, and stone needles were created since antiquity, and decoctions and wines were handed down for ten thousand years. The heavy responsibility of the Lord of Life has existed for a long time. However, diseases have different causes, varying from person to person; symptoms have transmission and changes, diverse in nature. Differences in onset and progression, distinctions of cold, heat, deficiency, and excess, yin and yang waxing and waning become more illusory and transformative; attacking and tonifying, complying and opposing become more extraordinary. Safety and danger reverse under three fingers; life and death hinge on a single spoonful of medicine. One must brew elixirs and study the *Ling Shu* and *Su Wen* to enter the inner chambers and ascend the hall. Only my teacher, Master Li Xiuzhi, possesses brilliant innate talent and profound family learning. Drinking water from the upper pool, he sees through walls like looking through glass; administering small doses, chronic diseases rise instantly; giving pills, the fallen revive. The mountains of Jiufeng and lakes of Sanmiao are transformed into springs of longevity. Yi looks up to his model, personally receiving the example of the Dao. Fortunately, the great smith's furnace and hammer awaken the deaf, and teaching inscribed on the belt has been ongoing for years. Comrades worry that the illumination is not widespread enough, asking me to record the cases. Thus, I dare to offer my humble views and respectfully state a few words. Although the sea of learning is deep, hard to measure with a ladle, and many scholars gather at Longmen, why rely on peering through a tube? However, seeing the high mountain, how dare I slack off? Since the discussion is here, I borrow pen and tongue. Recording what I have seen and heard, generally describing from high officials to merchants and shepherds, among them strange diseases and unique formulas, some revive the dead, some nourish qi and preserve truth. Sometimes tonifying yang harmony, like frost meeting the sun; sometimes regulating yuan and nourishing water, like sweet rain falling. Flexible and lively, never departing from the grace of returning to spring; adapting to circumstances, all becoming benevolence benefiting others. May the world and future generations know my teacher's merit of saving lives, connecting upwards with Cang Gong. As for writings hidden in golden chests, compiled and secreted in jade boxes, extracting ten thousand volumes of books, shaking the bell of a thousand autumns, this is the divine妙 (wonder) of my teacher's entry into spirit. I have no knowledge, how dare I peek at even a fraction? Tang Tingyi, Shenjiang, bows respectfully.
Hou Zishe from Zouyi, Shenjiang, suffered from diarrhea in mid-summer. Spirit was exhausted, face and eyes blue-yellow. Because he usually did not take medicine, it dragged on until late autumn. Suddenly, he fainted from dizziness, limbs convulsed, mouth skewed, lips moving, whole body cold, face black, abdomen shrunk, six pulses absent.幕宾 (guest physicians) in the office understood medical principles and expressed their own views. Some said: "All wind-induced tremors and dizziness should be treated by calming the liver." Others said: "All cold-induced contraction should be treated by dispersing." Discussions were chaotic, daring not to prescribe. They invited me to decide. I said: "The spleen has the duty of raising yang; the stomach is the mansion of moving qi. When Kun Earth prospers, clear yang spreads everywhere; when Qian Heaven malfunctions, turbid yin blocks. This is the natural law. Now, prolonged diarrhea has consumed harmonious qi, so spleen yuan descends, stomach qi floats up, yin and yang are blocked, forming the 'Pi' (stagnation) of heaven and earth. Hence sudden fainting, as said, 'When earth is empty, it collapses.' Moreover, the liver and spleen meridians are mutually overcoming organs. Spleen deficiency leads to wood prosperity; prosperity generates wind. Thus, cold body, blue face, skewing, and convulsions occur sequentially. If mistakenly diagnosed as wind-cold and treated with releasing exterior formulas, the lost yang will never return. It is urgent to decoct a large dose of Ginseng and Aconite to treat the root." The whole office was surprised by my strict and accurate reasoning. They used one liang of Ren Shen (Ginseng Radix), two qian of Shu Fu Zi (Prepared Aconite Lateral Root), and five slices of fresh ginger, decocted and administered. Within one to two hours, fingertips warmed slightly; by midnight, body was warm, spirit revived, able to drink rice water. Later, managed with Lizhong Wan and Buzhong Yiqi Wan, and he recovered.
Lu Yuanzhen, a scholar, lay bedridden for a year. Knees and feet were withered and thin, ear rims scorched and thin, appearance haggard. Visiting many famous doctors, all used Siwu Tang combined with Dihuang Wan, but he felt chest oppression, decreased appetite, believing his body was permanently ruined, yet his heart was not satisfied. Invited me to discuss treatment. Pulse at both cun and guan positions was deep and stagnant, only chi position was surging and large, heavy pressure seemed absent. This is a sign of kidney deficiency, essence depletion, marrow emptiness, and bone flaccidity. The kidney is the official of strength, located below, governing yin qi, storing essence and filling marrow. Thus, when kidney prospers, essence is full, joints and bones are strong; when kidney is deficient, marrow is exhausted, knees and patellae are weak. Wang Taipu said: "To nourish the seedling, one must solidify the root; to cut the lower, the upper must wither." Now, Kan Water cannot irrigate meridians and nourish the hundred bones, hence ear rims scorched, knees and feet withered. The *Neijing* says: "When kidney qi is hot, waist and spine cannot move, feet cannot bear weight, bones wither, marrow decreases, developing into bone flaccidity." This perfectly matches this case. If merely treating with yin-nourishing herbs, fearing that grass and trees cannot suddenly replenish essence and blood, instead blocking yang qi, causing epigastric discomfort. Difficulty in walking requires using substances of blood and qi seeking similar categories, combined with messengers reaching directly to the lower jiao, like rain filling ditches and overflowing rivers. Why worry about tunnels not functioning and difficulty walking? Prescribed: Ren Shen (Ginseng Radix), Baizhu (Atractylodis Rhizoma), Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Fuling (Poria), Rougui (Cinnamomi Cortex), Lurong (Deer Antler Glue), Guijia (Tartar Testudinis Carapax et Plastrum), Weirou (Polygonati Odorati Rhizoma), Niuxi (Achyranthis Bidentatae Radix), etc., in heavy doses. After several doses, slight relief; after a hundred doses, cured.
Eldest son of Lu Yougong, a Xiaolian from Jiading, had fever in childhood. Tried cooling medicines extensively, heat intensified, day and night without reduction. Again diagnosed as Yangming heat syndrome, given large doses of Baihu Tang, forbidden grain food, leading to muscle wasting and gradual critical condition. Invited me to treat. Face was withered and lusterless, pulse fine and rapid. Firmly diagnosed as severe deficiency, urgently using sweet-warm medicines to salvage. Mr. You shocked: "All say external cold-heat has no interval, internal cold-heat is uneven. Now fever continues day and night, yet you speak of internal deficiency. Must have firm view, wish to hear details." I said: "Yang deficiency worsens by day; yin deficiency worsens by night. This is yin-yang partial excess, having boundary divisions. Now spleen and stomach are both deficient, yin and yang both diseased, primordial qi depleted, yin fire attacks, floating only on skin. Although surface feels hot as burning, cold must hide inside. Moreover, muscle wasting, spleen yuan exhausted. Sleepless all night, stomach qi disharmonious. No color on face, blood and qi not flourishing. Pulse lacks spirit, heavenly truth weak. These are clear proofs of insufficiency. If forbidding sour flavors, stomach qi becomes lonely; exclusively taking cold-cool, vital qi extinguishes. Should take Buzhong Yiqi Tang plus Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) in morning to cultivate the root of life; take Xiaoyao San in evening to soothe the depression of Yi Wood (Liver), accompanied by rich fresh foods to revive stomach and nourish yin, so primordial spirit fills and deficient yang内敛 (internally contains)." Ordered to first drink one bowl of pig lung soup, immediately slept peacefully, heat slightly reduced, then trusted medication. After ten doses, spirit refreshed; managed for a year, gained several jin, finally fully recovered.
Chen Gong, Governor of Changzhen, suffered from lower bleeding for a long time. Summoned me in spring of Jiachen year. Pulse six positions calm, right chi heavy pressure slightly deficient. This is Mingmen Fire decline unable to generate Earth, Earth deficiency weak, essence and micro-descend forming stool blood syndrome. Earth is the mother of generation and transformation, dike preventing downward qi. Classics say: Ying (Nutritive) comes from Middle Jiao; also, Qi originates in the middle. Middle refers to spleen and stomach, hometown of generating qi and blood, duty of ascending clear and descending turbid. Thus, when stomach prospers, blood following meridians spreads outside; when spleen strengthens, blood guarding nutritive nourishes inside, all relying on mild fire generating qi. If primordial yang is deficient, Li (Fire) void cannot generate Kun (Earth), Kan (Water) full cannot nourish Gen (Mountain), causing spleen and stomach decay, clear yang not ascending, transport losing transformation, yin blood not controlling. Essence qi cannot offer to Xin Metal (Large Intestine), instead seeps down to Geng Large Intestine. Should use sweet-warm agents to cultivate Middle Palace deficiency, lifting agents to raise sunken qi, so growth command executes and yin blood returns to storage. Formula: Buzhong Yiqi Tang plus Ejiao (Donkey-hide Gelatin) stir-fried with vinegar, Jingjie (Schizonepetae Herba), several doses and peace.
Zhang Luyan, Civil Selection Official from Baoding, passed exams young, indulged in wine and lust, suffered stool blood for four years, once at noon, once at morning. Various medicines mixed, many doses little effect. Invited me to treat. Pulse both hands floating and surging, diagnosed as kidney deficiency fire movement syndrome. Blood is refined from essence, essence full then blood thrives; yin follows yang movement, yang dense then yin solid. Sexual excess, true water deficient, deficient fire alone erupts; primordial qi insufficient, closure relaxes, yin not solid. Then used Shudi (Rehmanniae Radix Preparata), Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Shihu (Dendrobii Caulis), Guishen (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Qinjiao (Gentianae Macrophyllae Radix), E'jiao (Donkey-hide Gelatin) fermented, decocted, mixed with two qian of Cottonseed Ash, taken warm on empty stomach. Several doses then cured.
Madam Lu Fujijiu, scholar, granddaughter of Dong Wenmin Gong. Pregnant three months, suddenly burst like a spring, fetus fell, placenta stopped, bloating oppression, coma, fever, delirium, looking up seeing ghosts, face black, drooling, already three days. All these are stasis blood filling uterus, covering heart and lungs above, thus evil signs fully appear. Treatment method must distinguish priority, use Rougui (Cinnamomi Cortex), Guiwei (Angelicae Sinensis Radix Tail), Zelán (Leonuri Herba), Xiangfu (Cyperi Rhizoma), Honghua (Carthami Flos), Niuxi (Achyranthis Bidentatae Radix), Yuanhusuo (Corydalis Rhizoma), decocted, mixed with Shixiao San (Formula) to remove uterine filth, prevent rising. Follow with Renshen (Ginseng Radix), Huangqi (Astragali Radix), Xiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Rougui (Cinnamomi Cortex) to assist transmission, perhaps save. As prescribed, took medicine, spirit slightly clear, felt pain waves connected to waist,恍惚 (trance-like) as if falling, inserted goose feather into throat, vomited once, uterine expulsion bloating oppression bitterness lost.
Wang Gong, Assistant Garrison General, grew up in Jibei, pores closed dense. Gui Mao autumn, visited Lieutenant General Liang Gong in Rongcheng, enjoyed coolness, returned early, slept heavily midway, felt aversion to cold and fever. Because usually no illness, not careful in maintenance, overate fish and meat, daily increased panting, breath coarse, could not sleep on pillow, more sweat dripping, language broken, could not speak. Invited me to discuss. Six pulses surging and slippery, right cun and guan especially rippling. Combining pulse and syndrome, knew as phlegm-fire internally depressed, wind-cold externally bound, just wanting to exit but pathogen obstructs it, pathogen wants to go up but qi rebels against it, pathogen and righteous struggle, qi gathers in lung. Making respiration organ lose its regulation, clear and肃 (pure) qi becomes disturbance. Thus breathing ascent and descent cannot diffuse and communicate, airway rushing develops lung sound. All visible signs are wind pathogen excess, lung qi obstruction signs. If can disperse cold and drive phlegm, all diseases self-heal. Then used San'ao Tang (San'ao Tang: Mahuang leaves without roots/nodes, Xingren seeds without skins/tips, Gancao raw. Note: This formula treats cold-wind cold, cough, nasal congestion. Mahuang leaving nodes has release and retention, Xingren leaving tip takes its ability to release, leaving skin takes its ability to astringe, Gancao raw has tonification with release, hence named San'ao) plus Juhong (Citri Reticulatae Pericarpium Rubrum), Banxia (Pinelliae Rhizoma), Qianhu (Peucedani Radix), one dose expectoration panting eased, two doses chest pleasant sleep peaceful. With Wang Gong's many desires, mistakenly recognized Dantian shortness of qi, used warm-tonifying crystals then stuck pores, how can guest pathogens diffuse, how can stubborn phlegm dissolve. Thus at clinical time must value careful examination.
Wu Weizong, merchant from Xian, nearing sixty, suddenly contracted hemoptysis and coughing phlegm, uneasy day and night. Doctor saw old age and much labor, mistakenly gave Renshen (Ginseng Radix) and Huangqi (Astragali Radix). Then felt a thread of foul air rush straight to clear pathway, like smoke and fog, chest隐隐 (dull) pain, panting urgent cannot lie down. Whole house weeping, specifically sent nephew far to visit humble door, fully stated illness overview, and said his son young age, if become chronic illness, who nurture, deeply pitiful. I pitied his earnestness, carefully examined. Knew water dry dragon rises, scorching delicate organ, will see rotting lung forming abscess, so coughing not stop. Gold and water are one qi, water and fire same origin, Qian Metal can generate water, Kan Water can nourish metal. Only source and flow mutual aid then Li flame no shine, like true water dried flow then minister fire flies over. Making clear void vast quality, become disturbed turbid qi. Moreover, sweet-warm assisting yang further injures lung fluid, should strengthen water master to suppress sunlight, make child come save mother then evil fire instantly rest. Formula: Sheng Dihuang (Raw Rehmanniae Radix) and Shu Dihuang (Prepared Rehmanniae Radix) each two qian, Tiantong (Asparagi Radix) and Maidong (Ophiopogonis Radix) each one qian five fen, Fuling (Poria), Ziwan (Asternis Radix), Chuanbei (Fritillariae Cirrhosae Bulbus), Kuqin (Scutellariae Radix), Gualoushuang (Trichosanthis Pulpa), Gancaojie (Glycyrrhizae Radix Node) each one qian, two doses then smoke dissipates fog scatters, panting sleep peaceful afterwards, modified not ten days then coughing phlegm all stop.
Wen Zhanchi, Chancellor, when in Left Chunfang, suffered left foot below a thread of fire rushing straight to epiglottis, burning throat, must lift shoulders several times, fire energy slightly retreats, moment later comes again, or use Buzhong Yiqi Tang plus Rougui (Cinnamomi Cortex) take it worse, sought treatment from my father. Pulse both chi soft deficient, knew not real fire rushing, but deficient inflammation floating up. However, among deficiency syndromes there is spleen-kidney distinction, spleen deficiency qi often sinks, method should lift, kidney deficiency qi often usurps up, again should tonify and collect. Now true yin declines consumed, lone yang no reliance, must nourish Kan yin, to suppress Li亢 (hyperactivity), then is correct treatment. Formula: Shudi (Prepared Rehmanniae Radix) four qian, Danpi (Moutan Cortex), Shanzhuyu (Corni Fructus) each two qian, Maidong (Ophiopogonis Radix) one qian half, Wuweizi (Schisandrae Fructus) three fen, Huangbai (Phellodendri Cortex) seven fen, Niuxi (Achyranthis Bidentatae Radix) one qian, decocted add boy urine one cup, take four doses then deficient fire retreats, left foot then cool.
Wang Litang, Canrong, wife worships Buddha long vegetarian, nature irritable much angry, abdominal distension accumulated years, past use decoction pills completely no effect. Invited me to treat, abdomen large umbilicus protruding, green veins ring appear, two hypochondria more severe. Panting full difficult lie down. This is anger injury liver, Kun palace controlled syndrome. Previous doctors only know calming liver method, unknown tonifying liver use, so Jia Gallbladder qi decline, harmony secretly donate, clear yang not ascend, turbid qi not descend, stagnate central region, distension trend more increase. Not know liver wood self-excessive then liver also self-injure, not only middle earth deficiency decay already. Method should regulate spleen midst combine with soothing liver crystal, make liver wood smooth then earth self-develop. Proposed formula: Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Rhizoma) each one qian half, Baishao (Paeoniae Radix Alba), Guangpi (Citri Reticulatae Pericarpium), Xiangfu (Cyperi Rhizoma), Fuling (Poria) each one qian, Rougui (Cinnamomi Cortex), Muxiang (Aucklandiae Radix), Shengjiangpi (Zingiberis Rhizoma Recens Pericarpium) each five fen, take after instantly feel abdomen sound distension widen, pant flat sleep peaceful, later add Renshen (Ginseng Radix) manage then fully recover.
Wang Zhenxian, wife from Xiuning, conceived eight months, prenatal tuberculosis, flesh削 (cut) muscle thin, around mouth dark black, tongue color red moist, diet as usual, six pulses slippery smooth, shape like no illness. I said: Nine inspections although harmonious, form flesh already shed, method in not treat, relied on fetal yuan lively, true yin not scattered; line breath lone yang, rely on Dantian. Like withered poplar grow flower, root already pulled, prenatal still have vitality, fear fifty days later although divine pill total hard retrieve. Give birth time, Ying and Wei both leave, hundred joints open, moreover place long illness body, when this painful realm, fear primordial spirit no reliance, yin yang sever, only display shell, then vital qi distant, how can extend? Two months later, fruit born mother died.