吴静山（敬权）孝廉令正钱夫人，时邪后遂发黄肿，日嗜干茶无度，苏太诸医，皆用气血并补，久而不愈。延余诊之。脉两手俱洪数之甚，询得腹中攻痛无常，夜则身热如烙，此由阴液不充，瘀滞干粘所致。宿血不去，则肢体浮肿。新血不生，则肌肉消瘦。一切补脾刚药，未可施于此证。考仲景治黄，有猪膏发煎润燥之法，爰仿其义，专用滋润之品，调养肾肝而愈。
前营游击温公（大勇）夏月自浦口来松，途中冒暑，到署后请医调治，初用清暑利湿不效，改用参术归地，转增脘痛。自后朝暮更医，佥言误补留邪，治难有效。遂延余诊。余见其身面发黄，总是胃腑结聚不行所致，用连理汤辛开苦降法，授方不服，遂就诊于青浦医家，方用茵陈五苓散等，服之亦不效。遂以绝证为辞，归至署中，计无复出，始委命以听余焉。予仍用前法，服参些少，是夜即得安寝，改用理中汤调理半月而愈。后以礼貌之衰，坚辞不往，升金山参将后，重发旧恙，遂成不治之证矣。
浊证医案
浊证湿滞为多，而亦有宜于温固者。上海徐德音浊下如涕，医不辨其为精浊，概以利湿
头痛医案
嘉定陈妪年五十有七，病头痛数年，额上为甚，额属阳明部分，久痛必虚，须填补阳明，之法治之，久不见效。渐至食则易饥，心火上亢，肾水下趋，形消腰折，寒热频频，督脉阳维交病。余谓此系精浊。非便浊也。用鹿角菟丝骨脂等温补下焦，兼服威喜丸而愈。
提宪稿房陈寿昌病浊，医者疑其肾阴亏损而致此疾，早投补肾药，少腹胀痛欲死。余用左金清火，合雄鼠粪汤攻浊而愈。兼鼓舞胃中清阳之气，用玉屏风散加炙草葛根，二剂全愈。推此而太阳头顶痛，少阳头角痛，厥阴头巅痛，皆可按法而治矣。
高桥镇曹连珍室，操持家事颇劳，兼多暴怒，孟夏得疾，自天柱至头巅，忽然强痛，坚重难移，两耳赤肿，胃中嘈杂，脉象洪数。宗喻氏治吴添官母例而愈。
腹痛医案
枫泾镇宋元英境享安闲，恣情房帏，患腹痛二年，医药不效，遂就诊于吴郡极时之医，以绝证为辞。宋即归家，料理后事，深信医言为不谬。余适过枫，晤宋氏西席程永孚，谈及医理，遂为知己。遂同元英来寓就诊，细按其脉，细询其证，总是阴阳悖逆，升降不利使然。问曰：曾服泻心汤，进退黄连汤否？曰未也。因酌一方以授，投一剂而稍平，数剂而全愈。
前余在嘉定，有乡人王四九官病膈，向服和中药，据述投三四剂辄效，逾时复然。就诊于予。投进退黄连汤不应，改用丹溪韭汁牛乳饮而愈。因知古人因证立方，不相假也。
胎前医案
胎前宜凉，人人知之。而亦有宜于温者，胎前宜补血，不宜破血，而亦有转用破血而得安者，总在临证时之细心体会也。郡城孙锦章室，怀胎五月，病转胞不溺，医用清利水道，并不究及转胞由于下焦虚寒，由于中焦气弱，由于肝家血滞，猪苓、泽泻、车前等药，徒伤胃气，故饮食减少，夜不得寐，诸恙渐臻，而胞系之缭戾者如故也。日请稳婆抬起，始得溺出。究之元气不支，日甚一日，因而延余诊治。余诊其脉，缓大有力，许以可救。遵《金匮》成例，投肾气汤一剂，是夜稍得安寝，盖利水之药，足以泻肾。投桂附而命门温暖，故稍得安寝耳。再遵丹溪补气成例，投参术汤一剂，饮食渐能知味，惟病者大便不行已数日，腹中至此更觉不安，改用茱连汤一剂，大便得解，小便虽仍稳婆伺候。病者因诸恙悉减，深信不疑，再求良治，余为沉思者久之，脉象比前益见有力，元气已复而胎气未举，必有瘀血阻塞其间，遂用大剂破血之药，一剂而胀遂消，三剂而胎气未举，凡破血之药，最足碍胎，今破血而胎反固，妙在先用补药以助其元气也。
产后医案
产后感冒时邪，宜温散，不宜凉散，人人知之。而亦有不宜于温而宜于凉者，误用温则不得不用大寒矣。归鞠氏侄女，冬月初产无恙，至六日头痛身热，凛凛畏寒，予用栀豉汤，夜半热退，逾日复热，更医用产后逐瘀成法，遂加烦躁。余谓冬温为病，清之可安。通评虚实论曰：乳子而病热，脉悬小者，手足温则生，仍依时邪治例，用白虎汤而愈。凡产后无产证而染他证者，即当以他证治之，而丹溪大补气血之言，却不可拘。仲景云：病解能食，七八日更发热者，此为胃实，大承气汤主之。夫阳明经中，仲景尚再三戒人不可轻下，而产后亡血既多，仍云承气主之，盖既为胃实自有不得不用之理，举一证而产后之挟实者可类推也。仲景云：产后下利虚极，白头翁加甘草阿胶汤主之。夫既曰虚极，仍用白头翁汤者，下痢中既有渴欲饮水热而下重之证，则白头翁汤自有不得不用之理。惟其虚极，故加甘草、阿胶以养其正，举一证而产后之挟虚者可类推也。
产后恶露不行，胸腹饱胀，温之通之，人人知之。而亦有不宜于温而宜于凉，不宜于通而宜于和者。东门鞠上玉室初产患此，其脉数大而疾，上兼鼻衄，余用当归二两煎汤，冲热童便与服，稍稍安稳，但恶露止有点滴耳。更医用炮姜等温通套剂，遂至胸腹增胀，恶露点滴不行，有欲依产后春温治例，大进苦寒之品，余曰：又非稳治。坚用归地丹芍等凉血和血之剂，十余日，恶露大行而全愈。凡产后病解能食，七八日更发热者，当作别病治。初产后即发热者，则仍作产后治。但各有寒热，两途不可不条分缕析。
郡城侯姓妇年三下有八，因元霄夜游，行走太劳，归即小产。医者皆以其胸腹有块，用逐瘀成法，每剂必加炮姜，俱未有效。后虽停药，而骨节如焚，积块愈大，小便艰涩，热痛异常。至三月初始延余诊，已奄奄一息。诊其脉沉伏之极，隐隐难寻，予固知其阴虚阳盛，但日期多延，宜用缓治。初投复脉减去姜桂，神气稍安，继投丹溪大补阴丸，诸恙悉减，终投本事虎杖汤，积块平复，淋痛皆除，不及一月，饮食大增而全愈。
得胜渡卫姓妇初产恶露不行，发热疼痛，中挟冬温伏气，医用逐瘀温经套剂，遂至热邪流注左腿，日夜难安，饮多食少，至冬至朝延予诊治。予变产后宜温之说，用凉血大剂，加通瘀解毒，四服全愈。
郡城张六老室，产后月余，崩中不止，时当暑月，医用和中养血，俱不能止，病已三日夜，视为必死。余诊其脉，浮大欲脱，连声索救，神气尚清，急令煎黄芪一两，当归一两，服之顷刻立止。古方当归补血汤，黄芪多于当归五倍，今加当归与黄芪等分者，时当暑月。恐黄芪之过亢也。
血厥医案
郡城七星桥翁氏女经前发厥，厥必数日不醒人事，医用朱、黄、胆星之属，经年不效。己卯六月，延予诊治。脉象搏指，余谓此系经血内瘀，久而发厥，非痰迷心窍也。朱、黄、胆星，焉能破瘀生新耶。乃合《内经》乌鲗骨丸，仲景旋复花汤，河间金铃子散为一方，数剂全痊，竟不再发。
Wu Jingshan (Jingquan), a Xiucai, presented with his wife, Madam Qian. After contracting an epidemic pathogen, she developed jaundice and edema. She had an uncontrolled craving for dry tea daily. Various physicians in Suzhou and Taicang treated her with methods tonifying both Qi and Blood, but the condition persisted without improvement. I was then invited to examine her. The pulse on both hands was extremely surging and rapid. Upon inquiry, it was found that she suffered from unpredictable abdominal pain, and her body felt hot as if branded at night. This was caused by insufficient Yin fluids and stagnation of blood causing stickiness. When old blood remains, limbs swell; when new blood is not generated, muscles emaciate. All rigid and drying spleen-tonifying herbs are unsuitable for this syndrome. Studying Zhang Zhongjing’s treatment of jaundice, there is the method of using Pig Fat and Hair Decoction (Zhigao Fa Jian) to moisten dryness. Therefore, imitating its principle, I exclusively used moistening agents to nourish the Kidney and Liver, resulting in recovery.
General Wen Dayong (Dayong) of the Former Camp arrived in Songjiang from Pukou in summer. He was exposed to summer heat during the journey. After arriving at the office, he sought medical treatment. Initially, clearing summer heat and promoting diuresis failed. Switching to Ginseng, Atractylodes, Angelica, and Rehmannia aggravated epigastric pain. Physicians changed frequently thereafter, all agreeing that mistaken tonification had retained the pathogen, making cure difficult. I was then consulted. I observed yellowing of the body and face, which I attributed to accumulation and obstruction in the Stomach organ. I prescribed Lianli Tang (Coptis and Gastrodia Decoction) using the method of acrid opening and bitter descending. The patient refused it and consulted a physician in Qingpu, who prescribed Yinchen Wuling San (Artemisia Capillaris and Five-Ingredient Poria Decoction) among others, which also failed. Declaring it a terminal case, he returned to the office, having exhausted all strategies, and finally entrusted his life to my care. I continued with the previous method, adding a small amount of Ginseng. That night, he slept peacefully. Subsequently, Lizhong Tang (Regulate the Middle Decoction) was used for half a month until recovery. Later, due to perceived discourtesy, I firmly declined further visits. After his promotion to Senior General of Jinshan, his old illness recurred, becoming incurable.
Case of Turbid Urine Syndrome
Turbid urine syndrome is mostly due to dampness stagnation, but warming and consolidating methods are sometimes appropriate. Xu Deyin from Shanghai had turbid discharge resembling mucus from the lower jiao. Physicians did not distinguish whether it was essence turbidity or urinary turbidity, generally treating it with damp-draining methods.
Case of Headache
An elderly woman in Jiading, aged fifty-seven, suffered from headache for several years, most severe on the forehead. The forehead belongs to the Yangming region. Chronic pain implies deficiency, requiring supplementation of the Yangming channel. However, long-term treatment showed no effect. Gradually, she developed easy hunger after eating, hyperactive Heart Fire, sinking Kidney Water, emaciation, lumbar curvature, frequent alternating chills and fever, involving both the Du vessel and Yangwei vessel. I determined this was essence turbidity, not urinary turbidity. I used Deer Antler, Cuscuta, and Dogwood Cortex to warm and tonify the Lower Jiao, combined with Weixi Pill, resulting in recovery.
Chen Shouchang, clerk to the Provincial Surveillance Commissioner, suffered from turbid urine. Physicians suspected Kidney Yin deficiency and administered kidney-tonifying drugs in the morning, causing severe lower abdominal distension and pain. I used Zuojin Wan (Left Metal Pill) to clear fire, combined with Male Rat Feces Decoction to attack turbidity, resulting in recovery. To stimulate clear Yang Qi in the Stomach, I used Yupingfeng San (Jade Windscreen Powder) with roasted Licorice and Kudzu Root. Two doses led to complete recovery. From this, one can infer that Taiyang vertex headache, Shaoyang temporal headache, and Jueyin vertex headache can all be treated according to their respective methods.
The wife of Cao Lianzhen from Gaoqiao Town managed household affairs with great exertion and suffered from frequent anger. In early summer, she fell ill with sudden, stiff, heavy pain from Tianzhu to the vertex, difficult to move. Her ears were red and swollen, stomach嘈杂 (discomfort/burning), and pulse surging and rapid. Following Yu Jia Yan’s precedent for treating Wu Tianguan’s mother, she recovered.
Case of Abdominal Pain
Song Yuanying from Fengjing Town lived comfortably but indulged in sexual activity. He suffered from abdominal pain for two years with no effect from medicine. He consulted a renowned physician in Wu Commandery, who declared it a terminal case. Song returned home to arrange his affairs, believing the diagnosis correct. I happened to pass through Fengjing and met Cheng Yongfu, Song’s tutor, discussing medical principles, becoming close friends. Accompanying Song to my residence, I carefully palpated his pulse and inquired about his symptoms. It was clearly due to rebellion of Yin and Yang and unfavorable ascending and descending. I asked: Have you taken Xiexin Tang or Jintui Huanglian Tang? He replied no. I formulated a prescription. One dose brought slight relief; several doses led to complete recovery.
Previously in Jiading, a villager named Wang Sijiu suffered from Ge syndrome (obstruction). He usually took harmonizing Chinese medicines, reporting efficacy after three or four doses, only for recurrence later. Consulting me, Jintui Huanglian Tang was ineffective. Switching to Danxi’s Leek Juice and Cow Milk Drink resulted in recovery. Thus, I know ancients formed prescriptions based on syndromes, without arbitrary application.
Case of Prenatal Care
It is known that prenatal care should favor cooling, though warming is sometimes appropriate. It is known that prenatal care should tonify blood and avoid breaking blood, yet breaking blood agents have been used successfully for peace of fetus. This depends on careful clinical discernment. Sun Jinzhhang’s wife in the prefectural city, five months pregnant, suffered from Zhuanbao (bladder displacement) with inability to urinate. Physicians used diuretics, ignoring that Zhuanbao could stem from Lower Jiao deficiency-cold, Middle Jiao Qi weakness, or Liver blood stagnation. Polyporus, Alisma, and Plantago seeds merely damaged Stomach Qi, reducing appetite and causing insomnia, worsening conditions while the bladder ligament remained twisted. Daily lifting by midwives allowed urination. Ultimately, Yuanqi (Original Qi) failed, worsening daily. I was consulted. Pulse was slow, large, and forceful. I promised salvation. Following the Golden Chamber precedent, I administered Shenqi Tang (Kidney Qi Decoction). One dose allowed slight sleep, as water-draining herbs drain Kidney, while Cinnamon Twig and Aconite warm Mingmen (Gate of Life), facilitating sleep. Following Danxi’s Qi-tonifying precedent, I administered Renshen Baizhu Tang (Ginseng and Atractylodes Decoction). Appetite improved. However, constipation for several days caused abdominal discomfort. Switching to Zhulian Tang (Evodia and Coptis Decoction) resolved stool. Urination still required midwife assistance. Seeing improvement, she trusted me completely and sought further treatment. Contemplating her pulse, which became more forceful, Yuanqi had recovered but fetal Qi was not yet established. Blood stasis likely blocked the area. I used a large dose of blood-breaking herbs. One dose reduced distension; three doses stabilized fetal Qi. Although blood-breaking herbs usually harm the fetus, here they strengthened it, thanks to prior tonification supporting Yuanqi.
Case of Postpartum Care
Postpartum exposure to epidemic pathogens requires warming dispersal, not cooling dispersal, which is common knowledge. Yet, cooling is sometimes appropriate; mistaken warming necessitates major cold herbs. The niece of Gui Ju gave birth safely in winter. On the sixth day, she had headache, fever, and aversion to cold. I used Zhichi Tang (Gardenia and Soybean Decoction). Fever subsided by midnight but returned next day. Other physicians applied postpartum blood-stasis removal methods, increasing irritability. I diagnosed Winter Warmth disease, treatable by clearing. Tongping Xu Shi Lun states: If a nursing woman has fever and suspended-small pulse, survival is indicated if hands and feet are warm. Following epidemic pathogen protocols, I used Baihu Tang (White Tiger Decoction), resulting in recovery. For postpartum patients with non-obstetric diseases, treat the specific disease; do not rigidly adhere to Danxi’s “major tonification of Qi and Blood.” Zhang Zhongjing stated: If after resolution of disease, appetite returns, but fever recurs after seven to eight days, this is Stomach excess, treated with Dachengqi Tang. Even in Yangming channel, Zhang warned against purgatives, yet prescribed them for postpartum blood loss cases where Stomach excess exists. This illustrates postpartum excess syndromes. Zhang also stated: Postpartum diarrhea with extreme deficiency is treated with Baitouweng Tang plus Licorice and Donkey-hide Gelatin. Despite extreme deficiency, Baitouweng Tang is used due to thirst and heaviness indicating heat. Licorice and Gelatin protect healthy Qi. This illustrates postpartum deficiency syndromes.
Postpartum lochia retention with chest/abdominal distension is typically treated with warming and moving methods. However, cooling and harmonizing are sometimes appropriate. The wife of Ju Shangyu from East Gate suffered this after first childbirth. Pulse was rapid, large, and swift, with epistaxis. I used two taels of Angelica decocted in water, mixed with hot child’s urine. She stabilized slightly, but lochia remained scant. Other physicians used dried Ginger for warming/moving, worsening distension and stopping lochia. Some suggested major bitter-cold herbs for Spring Warmth protocol. I rejected this as unstable. Persisting with Danggui, Rehmannia, Moutan, and Peony for cooling/harmonizing blood, lochia flowed heavily after ten days, leading to recovery. Generally, postpartum fever after seven-eight days with appetite return is treated as separate disease. Immediate postpartum fever is treated as postpartum condition. Cold and heat must be distinguished carefully.
A woman surnamed Hou in the prefectural city, in her thirties, miscarried after excessive walking during Lantern Festival. Physicians saw abdominal masses and used blood-moving methods with dried Ginger, ineffective. Stopping medication, bone joints burned, mass enlarged, dysuria with painful heat occurred. Consulted in the third month, she was near death. Pulse was deep, hidden, faint. I knew it was Yin deficiency with Yang hyperactivity, but chronicity required slow treatment. Initial Fu Mai Tang minus Cinnamon/Aconge calmed spirit. Then Danxi’s Dabu Yin Wan reduced symptoms. Finally, Bencao Huazhang Tang flattened the mass and removed dysuria/pain. Within a month, appetite increased, and she recovered.
A woman surnamed Wei from Deshengdu had postpartum lochia retention, fever, and pain, complicated by latent Winter Warmth qi. Physicians used blood-moving/warming meridians methods, causing heat to flow into the left leg, restlessness, polydipsia, poor appetite. Consulted on Winter Solstice morning, I abandoned postpartum warming dogma, using major blood-cooling herbs with blood-moving/antitoxic agents. Four doses cured her.
Madam Zhang, wife of Zhang Liulao in the prefectural city, suffered metrorrhagia for over a month postpartum during summer. Harmonizing/tonifying blood failed. After three days/nights, deemed fatal. Pulse was floating, large, nearly collapsing. She cried for help, spirit clear. I urgently ordered one liang of Astragalus and one liang of Angelica decocted. Bleeding stopped instantly. Ancient Danggui Buxue Tang uses five times more Astragalus than Angelica. Here, equal parts were used due to summer heat, fearing Astragalus’ excessive rising nature.
Case of Blood Syncope
Miss Weng from Qixing Bridge, prefectural city, experienced syncope before menstruation, unconscious for days. Physicians used Cinnabar, Scutellaria, and Pinellia preparations annually without effect. In June of Ji Mao year, I was consulted. Pulse was striking. I diagnosed internal menstrual blood stasis causing syncope, not phlegm confusing the heart orifice. Cinnabar, Scutellaria, and Pinellia cannot break stasis and generate new blood. Combining Eupolyphaga Pill from Neijing, Xin Yi Hua Tang from Zhang Zhongjing, and Jinlingzi San from Liu Hejian into one formula, several doses led to full recovery with no recurrence.