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Hui Xi Medical Cases
Written by Xu Lingtai in the Qing Dynasty

Preface
Yuan Mei (courtesy name Zicai, pseudonym Jianzhai), a Grand Historian, wrote in "Biography of Mr. Lingtai": "I wished to collect his extraordinary prescriptions and techniques to serve as a medical reference, thereby saving the common people. However, due to the haste, I could not obtain them, and only recorded a few cases from Ze Gengshi and Wang Lingwen, but the descriptions were not detailed. I deeply regretted this." This summer, Mr. Lv Shen [character missing] sent me a handwritten copy of one volume of *Hui Xi Medical Cases*, stating that he obtained it from Jin Fucun, a student of the Xu family. Reading it was like obtaining a rare treasure. Although the secret text did not detail the prescriptions and herbs sufficiently, its profound insight into pathogenesis and miraculous skills were sufficient to serve as a reference and save lives. Therefore, I arranged and edited it, humbly adding my insights, awaiting the judgment of experts, to have it printed and passed down to future generations. This is my earnest hope.

Wang Shixiong, Junior Scholar from Haichang, October of the Yimao Year (1855)

Wind Stroke

A patient surnamed Jin at Fengmen stood at his gate early in the morning and suddenly encountered fierce wind, resulting in deviation of the mouth and eye, and inability to speak due to locked jaws. The physician used Ren Shen (Ginseng), Gui Zhi (Cinnamon Twig), Fu Zi (Aconite Root), and other substances. This was the standard prescription for treating wind syndromes at that time. I was urgently summoned to examine him. His body was stiff like a corpse, face red, breath coarse, eyes staring fixedly, and pulse large. I prescribed a formula to dispel wind, resolve phlegm, and clear heat. The family promised a heavy reward and urged me to stay for several days. I said, "I am not a professional practitioner seeking livelihood; you may take the money and let me go." They insisted. I said, "Rather than being killed by erroneous medication, it is better to take these three doses. If he wakes up and can eat, no further medication is needed." Over a month later, he came to my home to express gratitude. Upon inquiry, he indeed recovered after taking three doses and dared not take any other medications. Only his legs and knees remained weak, and his arms were still numb. I prescribed a medicinal paste, and he fully recovered. This corresponds exactly to what the *Nei Jing* (Inner Canon) calls "empty evil and thieving wind" (Xu Xie Zei Feng). Treating it with acrid-hot and drying drugs was certainly wrong, and treating it with yin-nourishing and cloying drugs was also erroneous. The correct approach is to use acrid-cool drugs assisted by sweet-warm drugs, as clearly instructed in the *Nei Jing*.

Wang Shukui, an Envoy who had resigned from his post in Changlu and returned home, often told me of his numbness in hands and feet and excessive phlegm. I told him, "Your constitution is naturally robust and plump, and you enjoy drinking and eating rich foods. Phlegm flows into the meridians; moderation is advisable." One day, he suddenly fainted, lost urine control, had locked jaws, clenched fists, and rattling phlegm sounds, all indicating critical conditions. Physicians prepared decoctions of Ren Shen (Ginseng), Fu Zi (Aconite Root), and Shu Di Huang (Prepared Rehmannia Root), but they had not yet been administered. I palpated his pulse: surging, large, and forceful; his face was red, and breath coarse. This indicated fullness of phlegm-fire and closure of all orifices. Administering Ren Shen and Fu Zi would have caused immediate death. I used Xiao Xu Ming Tang (Minor Decoction to Extend Life), removing Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root), and added 1 qian of raw Da Huang (Rhubarb Root), ground into powder. To avoid suspicion from bystanders, I pretended it was another medicine mixed in. Relatives were uproarious. However, the Grand Madam trusted me and strongly advocated taking my prescription. After three doses, he regained his voice; after five doses, he could speak. Subsequently, I regulated him with phlegm-resolving and blood-nourishing medicines. After one month, his gait returned to normal.

Liu Songcen from Zhangyou Alley loved drinking and formed a group of drinking companions, gathering year-round. I advised against it without success. He was only forty years old. On New Year's Eve, he went to a shop to buy wine. While weighing silver, his hand trembled, the weight fell, and he collapsed. His jaws locked, and he was unconscious. He was rushed home. On New Year's Day, he sent for me. I gave him several pills of Zhi Bao Dan (Precious Treasure Pill) and instructed him not to take other medicines, fearing that if doctors knew he was a drinker and had recently taken a concubine, they would prescribe warming and tonifying agents. On the fifth day, I visited him. He had not taken the medicine. His pulse was wiry, slippery, and surging. He suffered hemiplegia, rigid jaw, and drooling. This was a syndrome of damp-phlegm lodging in meridians and transmitting to fu organs. I treated him with phlegm-expelling and damp-draining substances. After over a month, he recovered. One hand and one foot remained less flexible, and speech remained difficult. Initially childless, after recovery, he had children who grew up healthy. He died at seventy-three. Who says stroke patients cannot live long? Diseases affecting meridians, sinews, bones, and joints are diseases of the physical form. They can prolong life but cannot be completely eradicated. Seeking complete cure through heavy dosages will inevitably harm life. Wealthy people hearing such views not only disbelieve but become angry. Flatterers then collectively prescribe warming and tonifying drugs, leading to death, with no one repenting.

A patient surnamed Wang outside the West Gate met a friend on the road during the New Year. After bowing, he collapsed, jaws locked, eyes closed, limbs paralyzed, and became unconscious upon return. Doctors also used Ren Shen (Ginseng) and Shu Di Huang (Prepared Rehmannia Root). His mother had previously been critically ill and cured by me, so she trusted me and sought help. I said, "This is 'empty evil and thieving wind'." I prescribed modified Xiao Xu Ming Tang (Minor Decoction to Extend Life). Doctors were shocked, arguing that a young man suffering this must have severe deficiency and could not tolerate strong drugs. His mother dismissed their objections and administered the medicine. The next day, he pulled my robe, stood on the ground, and attempted to kowtow. I asked, "Do you wish to thank me?" He nodded vigorously. I stopped him. He appeared tearful and grateful. I comforted him and told his mother, "The wind-toxin has penetrated deeply, causing stiffness of the tongue root. Although the illness has resolved, speech cannot return immediately. Do not panic and mistakenly administer warming and tonifying drugs." Indeed, he could speak after over a month and fully recovered after one hundred days.

Xi Yiwan from Dongshan, over sixty years old, suffered from wind-bi (painful obstruction). Contemporary physicians always prescribed warming and tonifying drugs. Fortunately, they did not heavily use Ren Shen (Ginseng) and Fu Zi (Aconite Root) as was common recently, so the condition was not severe. I palpated his pulse: surging and vigorous. This indicated a constitution with strong primordial qi, merely filled with phlegm-fire. I cleared fire and resolved phlegm to treat the branch (symptoms), and nourished blood and smoothed qi to treat the root. However, phlegm in the meridians cannot be completely cured; it does not affect lifespan and can allow survival for ten years. Using mild formulas adjusted as needed, he was nursed back to health over several years and died in his seventies. This illustrates that when the person is solid and the syndrome is excess, nurturing righteousness and driving out evil through harmonization allows for longevity. Heavy drugs damage righteousness and hasten death.

Shu Zijing, usually healthy, was dining with relatives and friends one day. When eating the second bowl, halfway through, his head suddenly dropped, and his chin fell. Companions asked, "Are you drunk?" No response. "Is your throat blocked?" No response. Observing closely, his eyes were closed, saliva flowed from his mouth, and he was moved to another seat where his neck was tilted, pulse absent, phlegm rattling, and consciousness lost. I urgently administered Zhi Bao Dan (Precious Treasure Pill). He initially refused but swallowed it upon second attempt. Soon, he opened his eyes and asked, "Where is this?" I explained. He said, "I want to go home." He was placed in a sedan chair and brought home. I prescribed wind-dispelling, phlegm-resolving, and spirit-calming substances. He could rise the next day, though weak. It never recurred. This is generally termed sudden collapse (Zhong Chu). There are food syncope, phlegm syncope, and qi syncope. Etiologies differ. Without prepared medicine, qi fails to enter, meridians close, and death occurs within half a day. If Ren Shen (Ginseng) and Fu Zi (Aconite Root) are used to assist fire and phlegm, no one survives. Upon death, it is assumed the disease was incurable and not due to error in warming/tonifying. This is the norm worldwide.

Wang Shixiong notes: *Zi Sheng Jing* states: Someone suddenly felt intense heat in the heart and abdomen. Others said this was a sign of wind stroke, but wind-dispelling drugs did not induce wind. A magistrate in Yiling suddenly suffered intense heat in summer, sprinkled water on the ground, lay on a bamboo mat, and had someone fan him. The next day, he died of wind stroke. People blamed him for lying on the wet mat and using a fan. Later, an old woman from Liyang presented identical symptoms and recovered after taking Xiao Xu Ming Tang (Minor Decoction to Extend Life). Comparing these cases reveals that wind stroke arises from excessive internal heat. Xu’s discussion aligns with this. The *I Ching* says: "Wind comes from fire." Proverb: "Extreme heat generates wind." Why do people fail to realize this? If Ren Shen (Ginseng) and Fu Zi (Aconite Root) are applicable, it is the treatment for collapse syndrome (Tuo Zheng), which must not be mistaken for application in closure syndrome (Bi Zheng).

Fear of Wind

Mu Yanbi, Vice Commander-in-Chief of Huzhou, had a very robust constitution. Suddenly, his jaws locked, preventing eating and drinking. He fasted for five days. I was invited to treat him. He received visitors normally, only complaining of hunger. I examined his teeth; the opening was a narrow slit. Palpating his cheeks, the skin was hard as leather. Studying the condition carefully, I could not understand the cause. I asked, "This is caused by fierce wind. Have you been exposed to fierce wind?" He said, "No." Then he realized, "Indeed! Twenty years ago, while camping outside the border, a strange wind arose at midnight, blowing away the tent. Three people died instantly; I was one of them. Hot water was poured on us; two survived, one died. I woke up unable to speak for two days. Could it be recurring now?" I said, "Yes." Jokingly, I said, "Leather workers soften hard leather. I intend to use medicine to soften your cheek skin." I applied centipede heads, scorpion tails, Po Xiao (Mirabilite), Peng Sha (Borax), Bing Pian (Borneol), and She Xiang (Musk) inside his mouth. Outside, I applied Da Huang (Rhubarb Root), Ya Zao (Gleditsia Sinensis Fruit), Chuan Wu (Aconitum Carmichaelii), and Gui Xin (Cinnamon Heart). Saliva and phlegm were expectorated. The next morning, before I rose, Mu opened the door and said, "Truly a immortal! I have already eaten several bowls of porridge." I then prescribed a wind-dispelling and blood-nourishing paste, and he recovered. Generally, when pathogens penetrate deeply, they lie dormant in zang-fu organs, bones, and vessels. When essence and qi are vigorous, they do not manifest. When blood and qi decline, or upon contact with triggers, recurrence can happen even after decades. This applies to both internal and external conditions and should be known.

Wang Shixiong notes: Skin頑痹 (stubborn numbness/obstruction) requires external treatment. Because it was hard as leather, toxic and potent substances were used.

Generalized Bi

A patient surnamed Wang from Wucheng suffered from generalized bi syndrome, with pain throughout the body and paralysis of limbs. He cried day and night, ate very little, and believed he would die. He wanted me to decide his fate. His family tears accompanied him to the boat. I examined him and said, "This is Li Jie (joint-penetrating) syndrome." The disease is in the sinews and joints; decoctions and pills cannot cure it. External treatment is required. Following ancient methods, I applied compresses, poultices, steaming, and fumigation. After ten days, pain decreased slightly, and limbs moved. He was sent home and recovered after a month. Generally, diseases of Ying (Nutritive) Qi, Wei (Defensive) Qi, and zang-fu organs can be treated with oral medicine reaching the site. Meridians and sinews/joints are tangible structures. The power of decoctions/pills: if too light, it cannot attack evil; if too heavy, it harms righteousness. Medicines with thick aroma and heavy power, applied via compresses, poultices, fumigation, and steaming, penetrate deeply to draw evil out. Ancients emphasized acupuncture and moxibustion. Physicians ignore this, first trying wind-dispelling drugs, then warming tonics when ineffective, allowing evil to linger. Even if not fatal, the patient becomes disabled. This happens everywhere; how unjust!

Wang Shixiong notes: Wind-dispelling drugs consume Ying fluids; warming tonics fill the collaterals. Both assist evil and increase pain. Light, bland, clearing, and unblocking agents are suitable for frequent administration; relying solely on external treatment is insufficient.

Fei (Paralytic Syndrome)

Shen Yougao from Xinguo remarried a young wife and failed to exercise restraint. Suddenly, he suffered panting, syncope, slurred speech, confusion, and inability to lift limbs. Doctors treated him for wind stroke, worsening the condition. I diagnosed, "This is Fei syndrome described in the *Nei Jing*." Shaoyin (Lesser Yin) deficiency leads to discontinuity of essence and qi. It is completely different from typical hemiplegia, wind stroke, phlegm syncope, or wind syncope. Liu Hejian’s Di Huang Yin Zi (Rehmannia Decoction) was established precisely for this. Why do doctors fear it? After one dose, panting ceased, spirit cleared, voice returned, and limbs moved. After three doses, eight or nine parts of the illness disappeared. Regulated with essence-nourishing and qi-boosting substances, he recovered. Among similar stroke cases I have seen requiring warming tonics, this was the only one. I record this to show I do not forbid tonics but insist on accurate syndrome differentiation.

Wang Shixiong notes: Ancient texts say true wind stroke is excess, while simulated wind stroke (Lei Zhong) is mostly deficiency. This is not entirely true. If a person has innate yang excess, overconsumes rich/greasy foods, accumulates heat transforming into phlegm, and blocks collaterals, they often suffer simulated wind stroke. Treatment should focus on resolving phlegm and clearing heat to free joint mechanisms. Throughout, tonics and stagnation-inducing agents are contraindicated. Xu’s statement that warming tonics are rarely suitable is indeed based on experience.

Cold Damage

A patient surnamed Ni from the firewood market in Suzhou suffered from Cold Damage (Shang Han) due to failure to purge. He was comatose, panted, and had a scorched tongue. His family had prepared funeral arrangements. I was about to leave for Yangzhou, docking at Tongjing Bridge, right past his house. In the evening, as I boarded, his son wept and begged for treatment. I said, "This is a Da Cheng Qi Tang (Major Order the Qi Decoction) syndrome." No modifications needed. I wrote the prescription. I warned, "If one dose does not produce stool, take another. Stop once stool passes." I then left for Yangzhou. Returning a month later, he was as strong as before. Such is the efficacy of ancient formulas. Whenever ancient formulas match the disease and syndrome exactly, no modification is needed. If the disease is the same but the syndrome differs slightly, modify according to the syndrome. The principle is clear, yet people fail to apply it. Purging when not indicated leads to Jie Xiong (Knotted Chest), causing people to fear purgatives. Such inversion stems from failing to study Zhang Zhongjing’s *Shang Han Lun* (Treatise on Cold Damage) deeply.

Amputated Foot Cold Damage

A patient surnamed Huang from Jiashan had external contraction combined with stagnant heat. Random medications were given, followed by tonics. Evil remained in meridians with no exit, sinking into the feet. Both calves were red, swollen, and extremely painful. Qi rebelled upward to the heart, causing crying and insomnia. I said, "This is Amputated Foot Cold Damage. The foot will fall off." Urgently, I used external fumigation and steaming to raise toxicity and dissipate stasis. Internally, I used pills and powders to resolve phlegm-fire and transform toxic saliva, expelling them via stool. Externally, I used acrid-cool decoctions to support unexposed evil. He stabilized in three days. Generally, wind-cold lingering in meridians without release often transforms into abscesses: upper face (Fa Yi), middle lung/liver/spleen abscesses, lower intestinal abscesses or groin sores. Externally, it disperses as macules, rashes, or ulcers. In joints, it causes wasting, bi, or spasms. In calves, it causes foot issues. These conditions are recorded in the *Nei Jing*. Since internal and external medicine separated, these conditions are largely unknown.

External Contraction with Food Stagnation

Yang Xiulun, a wealthy merchant from Huai'an, aged 74, had external contraction with food stagnation. Doctors argued that due to his age and wealth, he required tonification. Consequently, he vomited at the smell of rice, scolded others for eating ("How can you eat such smelly stuff?"), and abstained from food and sleep for a month, surviving only on Ginseng soup. He hired me. I diagnosed, "This is curable, but you will not accept my prescription. If you don't take it, you will die. If I comply with your wishes, you will also die. Better not to prescribe at all." They asked, "What medicine?" I said, "Raw Da Huang (Rhubarb Root) is essential." Everyone was shocked. One said, "Let us wait for your prescription before discussing." His intent was likely to delay until the medicine was ready, then secretly discard it. Sensing this, I boiled the medicine, went to the patient, and forced him to take it. Bystanders were terrified. He took only half. That night, his breathing calmed, he slept, and had no diarrhea. The next day, he took the full dose, passed some accumulated feces, and felt more comfortable. Early morning on the third day, I was in my study when noise erupted outside: "The Old Master is sweeping the hall!" I dressed and asked. The messenger said, "The Old Master wanted to get up after lying down for long and wished to thank you personally." In the hall, fruit shells were piled up; he had swept them himself to walk. He entered my room and talked for a long time. At breakfast, seeing food, he picked a few grains, chewed them, and asked, "Why isn't it smelly?" From then on, diet gradually increased, and spirits returned to normal. Everyone thought it miraculous. I said, "Food stagnation causes aversion to food, known to all. Removing accumulated food restores appetite; this applies to young and old alike. Current doctors believe elderly food stagnation cannot be digested and only mid-Qi tonification is suitable, waiting for self-resolution. This nonsense is revered as gold standard, harming many unknowingly. My reputation in Huai'an and Yangzhou stems from this."

Seasonal Pathogen (Shi Zheng)

Ni Fuzheng from Xitang suffered from seasonal pathogen syndrome: confusion, rapid pulse, no eating or sleeping. Doctors deemed it deficiency and prescribed Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). This formula is universally used by Zhejiang physicians regardless of the disease. He could not swallow even a grain of rice, and irritability/heat worsened. Physicians were helpless. I diagnosed, "Heat evil remains in the stomach." External pathogens eventually return to Yangming. If evil is heavy with food, dry feces form, treated by San Cheng Qi Tang (Three Major Order the Qi Decoctions). If evil is light without food, hot phlegm forms, treated by San Xie Xin Tang (Three Drain the Epigastrium Decoctions). I used modified Xie Xin Tang and phlegm-resolving/appetite-stimulating medicines. He stabilized in two doses. Others thought it magical, not realizing this is simple logic found in the *Shang Han Lun*. Read carefully, and it is clear. Further misdiagnosis would mean no chance of survival.

Wang Shixiong notes: Han Yao, just over twenty, robust and a drinker, suffered occasional bleeding in spring. He widely took Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). In early summer, he developed fever and chest/abdominal distension. Doctors prescribed Xie Xin Tang (Drain the Epigastrium Decoction) and Xian Xiong Tang (Pierce the Chest Decoction). Distension spread to the lower abdomen, was tender to pressure, with paralogical diarrhea, urinary retention, worsening irritability, inability to swallow liquids, delirium, and scorched lips. Switching to Cheng Qi Tang (Order the Qi Decoction) and Zi Xue (Purple Snow) was like throwing water on stone. I examined him: thick yellow coating, not very dry; pulse slippery and rapid but empty/soft on pressure. Merely damp-heat blocking qi, disrupting ascending/descending functions. I used Zhi Ju Tang (Citrus and Magnolia Decoction) plus Bai Qian, Zi Wan, She Gan, Ma Dou Ling, Xing Ren, Hou Po, Huang Qin, decocted in Lu Gen (Reed Rhizome) soup. One dose: delirium stopped, urination resumed. Two doses: paralogical diarrhea stopped, chest relaxed. Three doses: thin gruel accepted. Six doses: chest/abdomen relaxed, porridge intake increased. Switched to clearing/nourishing method. Ten days later, dry feces passed, and he recovered. Others thought it magical, but it was simply appropriate treatment for the syndrome.

Another note: Dai Qi, a cloth merchant, suffered from summerheat-dampness this summer. I treated with clearing/resolving methods. Heat subsided, hunger returned. Family thought chronic fatigue meant deficiency and fed him tonifying foods. Three days later, bowel/bladder obstruction, limb swelling/pain, rebellious qi to heart, crying, insomnia. I was called again. Residual evil flared with food, blocking the stomach fu. Fu qi excess led to meridian qi blockage and joint dysfunction. I used Wei Jing Tang (Eupatorium Decoction) without Yi Yi Ren, adding Gua Lou Ren, Zhi Shi, Zhi Zi, Luo Bo Zi, Huang Qin, Jie Geng, decocted with Yuan Ming Fen (Niter). Externally, scallion white mashed with honey applied. Urination opened first, bowel movement followed. Recovered in three days.

Wandering Soul

Son of the Jiang family in the prefecture suffered from seasonal pathogen syndrome: persistent fever, confusion, delirium, chaotic pulse. I diagnosed, "This is Wandering Soul syndrome." Medication alone won't retrieve the soul. I sought methods to summon the soul. A neighbor elder said, "I heard devout prayer to the Kitchen God allows the patient to speak." The father followed this. The patient spoke: "I watched a play, the small stage collapsed, nearly crushed, frightened. Then I walked in the City God Temple. My soul fell there. Carry me back in a sedan chair." They went to summon. Next day, I re-examined. Patient said, "My soul reached the door, scattered by my father. Today, my soul lay on the quilt, knocked off by my mother folding it. Now I don't know where it is." Roaring incessantly. I comforted him, "Do not worry. I will return it to you." I prescribed spirit-calming and soul-anchoring drugs, added Zhu Xin Jian (Pig Heart Tip) and Chen Sha (Cinnabar), wrapped in crimson silk, suspended in the decoction pot. Warning: "After taking medicine and sleeping, do not startle him. Deep sleep means spirit reunites." Indeed, one dose brought peace. Regulated and recovered. Asked later, he knew nothing.

Lost Soul