未进食，病家犹以用补为嫌。慰之曰∶本内伤症，一补中益气疗之足矣，无奈粗工杂投，胃气转伤，不能即复，
今以药补之，以稀粥调之，不过数日，自然知味。不信，另延一医，重用承气汤，服至二剂，不得便，必反以为
前药补住。病转剧，无颜再延高，往苏中延薛楚玉。楚玉至，闻述病情及用药次第。曰∶既用熟地而便，效可知
矣，奈何举将收之功，而弃之耶？今无能为矣。病家目楚玉为党，究不之信。嗟乎！举天下学问之人，而尽目
之为党，为彼之医，不亦难乎！
吕东庄治友人董雨舟，夏月捣膏劳力，致感头疼发热，服解表之药不效。其长君方白来问。吕曰∶子不观
东垣《脾胃论》乎？服补中益气加五味、麦冬自愈矣。如言服之，顿安。复起作劳，仍发热头痛，别用清解药，
增甚。因同叶御生往诊之，四肢微冷，胸腹热甚，烦闷，腰坠下，小腹胀痛，不能小便。时旁观者以为重感邪
所致，力主发散。吕曰∶虚邪内郁，正以劳倦伤中，生气不足，不能托之使尽去，又过清凉，其火下逼膀胱，
责及水脏故然，安可攻也？请以滋肾饮子合生脉散与之何如？御生论与吕合，竟投之，得睡，醒，热解，小便
通矣。留方补之而别。翌日方白至，曰∶内热时作，烦闷头痛亦间发，恐邪不尽。曰∶余火未散，移热于上也。
用软柴、人参、白术、黄连、丹皮、甘草、茯神等而愈。
杨乘六治徐氏外家，劳倦发热，时作微热，倦怠嗜卧，下午更甚。医用发散两剂，咳嗽不绝，胁痛如锥。更
用清金泻火，泄利不止，不食不寐者旬日。脉之，浮分细软，沉则缓大，面色 白，眼光散大，舌胖嫩，淡白
而滑，两手厥冷而振。此劳倦伤脾，气虚发热，初时若用补中益气，一二剂即愈。乃误药，致咳嗽痛利，胃阴
被劫于前，中气重伤于后。乃拟人参、熟地、白术各一两，附子、炮姜各三钱，赤石脂、禹余粮、炙甘草各五
钱，浓煎大碗，徐服至一碗，即睡去，巳刻至戌分始寤，咳利俱除，胁痛如失，能进粥饮。服用前药，胃气渐
开，用调中益气，生金滋水而愈。
简某病感症，壮热，时微寒，嗜卧懒言，日轻夜重。或与羌、防发散，燥渴谵妄不食。脉浮数无序，重按
虚大无力，舌嫩黄，中间焦燥。此内伤似外感症，误表以劫胃阴，津枯液涸，火无所畏，而变生燥症也。与左
归饮加生地、当归、白芍，两剂便解热退。再诊，浮数俱除，虚火仍在，继起之病已退，初时之病未减。盖初
病因中气素虚而来，后病因胃阴暴伤而致，若不先救其阴，而即补其气，是为无制之阳邪树帜，而将垂绝之真
阴下石矣。今阳火既退，阴汁渐充，则初起之症可立除也。以补中益气汤合生脉，四剂而愈。（治内伤者，
类以补中益气为神丹，不可不三复此论。）
薛立斋云∶余性爱静坐观书，久则倦怠，必用补中益气汤加麦冬、五味、酒炒黑黄柏少许，方觉精神清妥，
否则夜间少寐，足内酸热。若再良久不寐，腿内亦然，且兼腿内筋自有抽缩意，致两腿左右频移，展转不安，
必致倦极方寐，此劳伤元气，阴火乘虚下注。丁酉五十一岁，齿缝中有如物塞，作胀不安，甚则口舌如有疮然，
日晡益甚，若睡良久，或服前药始安。至幸丑，时五十有五，昼间齿缝中作胀，服补中益气一剂，夜间得寐。
至壬寅，内艰之变，日间虽服前剂，夜间齿缝亦胀，每至午前，诸齿并肢体方得稍健，午后仍胀。观此可知
气血日衰，治法不同。
按∶立斋生平善用补中益气，据此病先下盛，服之宜矣。
柴屿青治沈阳司寇觉罗讳吴祥。延诊曰∶数日前因感冒风寒，至今未愈。其脉或两至一歇，迟而见代，并
非外感，乃虚寒凝结气血耳，用人参养荣汤。吴曰∶无力用参，以玉竹代之。此十月二十一日也，至次日告云∶
昨服药后，腰发板，转动必以人，以需人参，购觅可也。遂用参一钱。二十三日早诊之，脉气稍转，仍用原方。
午后两膝强硬，自令人以热面熨之，忽至发迷。再促诊，而医者数人，但云风寒，方用大表散，并欲下大黄。
及诸人去后，吴云∶伊芳等如何可信？仍服公药，但为斟酌之。乃于方内加参一钱，迨服至冬至，方断煎剂，即
以原方配合为丸，调理而康。向使吴公信任不笃，必至难保。
夏大儿年友，苏中陈雍喈，身热谵语，不甚辨人。太守苕溪陆祝三，因赴补在京，邀柴诊视，其脉大而无
力，此阳虚发热，拟用人参。陆惊而咋舌，以为断不可用，乃力任方从。一剂后身和，三剂热全退，调理月余而瘥。
少司马讳雅尔图，以扈从打围至德州，抱病给假回京。医投小陷胸汤一剂，顿即仰卧，神昏不语。又一医
进参三钱，神气稍苏，言语恍惚，恶食不寐。延诊，雅云∶素有肝病，遂述前方。按左关脉平和，惟心部空大。
此心家之疾，与肝无涉，用酸枣仁汤而愈。
周太守家人，发热不食，晚间怕鬼，因途中冒雨，食冷粽而起。柴曰∶脉无停滞，只见虚大，经所谓形寒
饮冷则伤肺，饥饱劳役则伤脾。此内伤所致，拟用人参，以价贵为难，遂用扁党六君子，加炮姜、大枣，数剂而愈。
太史周希用，丁卯场前，劳倦外感，身热委顿，两足无力，欲用发表之剂，未决。求治，右脉软弱，人迎
不紧，外感轻而内伤重。以补中益气治之，后用异功散数剂，病痊，遂联捷。
观察沈椒园，在侍郎时，家人某，新从山左回京，身热不食，沈以熟地等滋阴大剂进，遂呕吐增剧。求治
于柴，柴曰∶此伤胃气所致，非阴药所宜。用香砂六君子汤，治之而痊。
主政蔡修持令节，发热口渴，胸闷，舌纯黑苔，谵语，延医无效，已二十余日矣。诊之，脉气平弱，并无
外邪，投以滋阴之药，二剂不应。改用六君子加炮姜，一服，尚未效。后戴廷傅加制附一钱，吴茱萸五分，一
剂，汗出胸快。再剂汗出，胸中豁然，调理而愈。病固有如此之类者，毋粗忽也。
陆养愚治朱少湖，病已半年，先因房劳汗出，又伤食，用消导药后，乃梦遗头晕。自服人参少安，遂每日
五钱或一两，服至数斤，其病自汗身热，咳血痰逆，胸膈不舒，心口如物窒碍，手足时厥，头常晕，眼或昏暗
不见人，大便已六日不行。每头晕时，服参汤则稍止。脉之，气口及关弦滑而有力，左寸关浮弦似虚，尺濡弱。
此由肝有怫热，重以思虑房劳致虚。参虽中病，单服多服，益阳太过，化为热火，与积痰胶固脾胃，遂致热结
幽门，火逆上行，而动血动痰。向以恶寒汗泄，重帏浓褥，帕裹绵装，至是悉令彻去。以润字丸三钱服之，外
用蜜导法，去宿垢盆许。再用人参七分，归身、远志各一钱，枣仁一钱，山栀、茯神各一钱三分，煎好，入竹
沥一钟，一帖，即胸次豁然得寐。每日以前方润字丸数十粒，便润汗止，咳嗽痰血渐减，十服而安。
陆祖愚治潘洪宇，以过劳伤脾，脾虚而肺脏亦损，咳嗽痰喘，微寒微热。或以清凉滋补健脾消导月余，饮
食顿减，精神愈衰，仅奄奄一息耳。诊之，遍身疮癣，六脉如丝，言语轻微，夜苦无寐，大便则向来艰涩。乃
用人参、白术、贝母、枣仁、麦冬、生地为煎剂，另以人参、麦冬、五味为丸，五更吞下。每日服参约四五钱，
数日渐瘳。再以归、芍、生地、连翘、地榆煎汤，揉洗肚腹，大便通润。调理百余日而安。
陆祖愚治本府添设曾向缘，中气不足，宜服参、 。一日，午饭未几，啖杨梅过多，便胸中不快，身热头
眩，吐痰口渴，不思饮食，三日不更衣。或用楂、枳、芩、连、浓朴、二陈之类，三四剂，大便一次，去燥矢
数枚，而症如故。又用归、芍、知、麦、楂、芩，而腹满作呕。脉之，左三部浮微而弱，右三部浮大虚数。曰∶
脾胃虚弱，气不能运，故胸膈不舒，并有积滞也。况素不能服苦寒，岂可用芩、连之类？经云但治其虚，安问
其余。乃六君子汤加白豆仁、煨姜、大枣，二剂症顿减。再与补中益气汤数剂，遂霍然。
一人忧思不已，饮食失节伤脾，面色黧黑，环口尤甚，心悬如饥，又不欲食，呼吸短促，曰∶此脾气受伤
也。忧思不已，则脾滞而不行；饮食失节，则脾气耗而不足，阴气上入阳中也。经曰∶阳明症衰，面始焦，
故知阳之气不足也。遂以参、 、白芍、升麻、葛根、白芷、苍术、甘草、姜、枣助阳明生发之气而愈。
朱丹溪治一人，因劳倦发热，医以小柴胡汤、黄连解毒汤、（芩、连、栀、柏。）白虎汤等剂，反加痰气上涌，
狂言，目不识人，目赤上视，身如烈火，六脉洪数七八至，按之豁然，左略弦而芤。此因中气不足，内伤寒凉
之物，致内伤发热，又与苦寒药太多，为阴盛格阳之症。与补中益气汤加姜、附、大枣，二剂而愈。
陈三农治一友，饮食不均，远行劳倦，发热烦闷，症类伤寒，医禁食不与。诊之，言语轻微，手背不热，
六脉数而软，此真气不足，非有外邪也。力勉其进粥，乃与甘温大补之剂，恪服数日，热退而安。
陈三农治夏夫人，年已八旬，忧思不已，偶因暑浴，遂患发热头痛。医者以为伤寒，禁其食，而肆行解散。
越三日气高而喘，汗出如洗，昏冒发厥。诊其脉，大而无力，乃为之辨曰∶外感发热，手背加甚；内伤发热，
手心为甚。外感头痛，常痛不休；内伤头痛，时作时止。（辨内伤外感要诀，宜熟玩。）今头痛时休，而手
背不热，是为虚也。遂用参、 各五钱，白术、半夏各二钱，橘红一钱，甘草六钱，一剂减半，后倍参、术而痊。
一人年近四旬，发潮热，口干，喜饮冷水，或以凉药，服之罔效。四五日，浑身沉重，不能动止，四肢强
直，耳聋，谵言妄语，眼开不省人事，六脉浮大无力。此气血亏损之极，以十全大补汤去白芍、地黄，加熟附
子一服，鼾睡痰响，或谓服参、 、肉桂、附子之误。曰∶此药病交攻，不必忧疑。又进一服，过一时许，即
能转身动止。次日，连进数剂，则诸病潜瘳矣，此从脉不从症之治也。
李时珍治一人，素饮酒，因寒月哭母受冷，遂病寒中，食无姜蒜不能一啜。至夏酷暑，又多饮水，兼怀怫
郁，因病右腰一点胀痛，牵引右胁，上至胸口，则必欲卧。发则大便里急后重，频欲登圊，小便长而数。或吞
酸，或吐水，或作泻，或阳痿，或厥逆，或得酒少止，或得热少止。但受寒食寒，或劳役，或入房，或怒或饥，
实时举发。一止，则诸证泯然，如无病患。甚则热发数次，服温脾胜湿滋补消导诸药，皆微止，仍发。此乃饥
饱劳役，内伤元气，清阳陷遏，不能上升所致也。遂用升麻葛根汤合四君子汤，加柴胡、苍术、黄 煎服。服
后，仍饮酒一二杯助之。其药入腹，则觉清气上行，胸膈爽快，手足和暖，头目精明，神采迅发，诸症如扫。
每发，一服即止，神验无比。若减升麻、葛根，或不饮酒，则效便迟。大抵降多升少，禀受弱而有前诸症者，
并宜此药，活法治之。（《本草纲目》。）
薛立斋治府庠王以道，元气素弱，丙午丁未二年，以科场岁考，积劳致疾，至十二月间，其病盛作，大热，
泪出随凝，目赤面黯，杨手露胸，气息沉沉几绝，脉洪大鼓指，按之如无，舌干，扪之如刺，此内真寒而外假
热也，遂先服十全大补汤。曰∶既服此汤，其脉当收敛为善。少顷，熟睡，觉而恶寒增衣，脉顿微细如丝，此
虚寒之真象也。以人参一两，加熟附三钱，水煎，顿服而安。夜间，脉复脱，以人参二两，熟附五钱，仍愈。
后以大剂参、术、归身、炙草等药，调理而安。
一男子发热烦渴头痛，误行发汗，喘急腹痛，自汗谵语。用十全大补加附子治之，熟睡，唤而不醒，及觉
诸症顿退，再剂而安。
黄武选饮食劳倦，发热恶寒，误用解表，神思昏愦，胸发赤斑，脉洪数而无力。此内伤元气，非外邪也，
急用温补之剂。彼不从，后果殁。
王肯堂治外兄虞文华，病发热。一医审无身痛等症，知非外感，用平胃散加人参五分投之，热愈甚。（用平胃
亦无谓。）又一医至，诊之曰∶此人参之过也，亟汗之，汗而不解。又一医至，诊之曰∶邪入里矣，宜凉膈散下之。
煎成欲服，王适至，急止之。诊得六脉皆洪大搏指，举按有力，笑曰∶此医之所以误也。用茯苓补心汤加人参
六钱，麦冬三钱，枣仁一钱五分。时不卧九日矣，服药即鼾睡良久而苏，病已退。诊之，脉顿微弱，为治方，
每剂用人参四钱，枣仁、茯神、归、术、 、麦冬、川芎之类，令其多服不辍，遂别去。数日，以小便不利来
扣，令服导赤散。明日热复作，舌黑如墨，复延诊，脉复洪大。因连日所服药，皆减参三分之二，而导赤散中
又加花粉、山栀、黄芩等药，故病复作。亟令用人参六钱，合前诸药大剂投之，舌色始淡，热始除，小便亦清
利。倘进凉膈之剂，必不治，药可妄投哉。
马元仪治邱德初，素积劳郁，近复失恃过哀，因而发热恶寒，KT 逆烦渴，面赤如妆。诊其两脉沉微无力，
Wei Zhixiu recorded: The patient had not eaten, yet the family still harbored reservations about using tonifying medicines. I comforted them, saying, "This is fundamentally an internal injury syndrome; treating it with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) would suffice. Unfortunately, incompetent physicians have indiscriminately administered various drugs, further damaging the Stomach Qi (the vital energy of the digestive system), which cannot recover immediately. Now, by using medicinal tonification combined with thin porridge to regulate the diet, within a few days, the sense of taste will naturally return. If you do not believe this, you may invite another physician to prescribe Chengqi Tang (Major Order the Qi Decoction). After taking two doses, if bowel movements are not achieved, the patient will inevitably believe that the previous tonifying medicines caused stagnation. The condition will worsen, and out of shame, they will no longer seek high-level medical care, instead going to Suzhou to invite Xue Chuyu. Upon arrival, Xue Chuyu listened to the description of the illness and the sequence of treatments, and said, 'Since using Shudi (Prepared Rehmannia Root) yielded results, the efficacy is evident. Why abandon the success just as it is being reaped?' It is now beyond my ability to help. The family viewed Xue Chuyu as biased, yet ultimately did not believe him. Alas! To have all learned people in the world labeled as forming cliques, making it difficult for them to practice medicine—is this not too hard!"
Lv Dongzhuang treated his friend Dong Yuzhou. In summer, while pounding herbs under the sun and exerting himself, he contracted pathogens resulting in headache and fever. He took exterior-releasing medicines without effect. His eldest son, Fang Bai, came to inquire. Lv Dongzhuang said, "Have you not read Li Dongyuan's *Pi Wei Lun* (Treatise on the Spleen and Stomach)? Taking Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuweizi (Schisandra Berry) and Maidong (Ophiopogon Tuber) will cure it spontaneously." Following this advice, he took the medicine and was instantly relieved. Later, upon overexertion again, fever and headache recurred. Another physician used clearing and resolving medicines, causing the condition to worsen. Consequently, Lv Dongzhuang and Ye Yusheng went together to examine the patient. They observed slight coldness in the four limbs, intense heat in the chest and abdomen, irritability and oppression, a sensation of heaviness dragging down in the lower back, distending pain in the lower abdomen, and inability to urinate. Observers at the time believed it was due to a secondary pathogenic invasion and strongly advocated dispersing methods. Lv Dongzhuang said, "This is deficiency pathogens internally constrained. Precisely because fatigue and overwork have injured the Middle Jiao (middle burner), the generating Qi is insufficient to expel the pathogens completely. Furthermore, excessive use of cooling medicines has forced fire downward to press upon the Bladder, implicating the Kidney Water organ. How can attack methods be used? Would it not be better to administer Zishen Yinzi (Nourish Kidney Infusion) combined with Shengmai San (Generate the Pulse Powder)?" Ye Yusheng agreed with Lv's view, and the prescription was administered. The patient fell asleep; upon waking, the heat resolved, and urination became unobstructed. A prescription was left for continued regulation before departing. The next day, Fang Bai arrived, saying, "Internal heat arises intermittently, and irritability and headache also occur sporadically; I fear the pathogens are not fully eliminated." Lv Dongzhuang said, "Residual fire has not dispersed and has shifted heat upward." He prescribed Ruan Chaihu (Soft Coptis or similar variant contextually implying gentle clearing), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Huanglian (Coptis Rhizome), Danpi (Moutan Cortex), Gancao (Licorice Root), and Fushen (Poria with Hostwood) to achieve a cure.
Yang Chengliu treated a relative of the Xu family who suffered from fatigue-induced fever, with occasional mild fever, lethargy, and desire to lie down, worsening in the afternoon. The physician used dispersing medicines for two doses, resulting in incessant coughing and stabbing pain in the hypochondrium. Subsequently, medicines to clear the Lungs and purge fire were used, leading to incessant diarrhea, loss of appetite, and insomnia for ten days. Palpation revealed the pulse fine and soft on superficial pressure, but slow and large on deep pressure; the complexion was pale white, eyes wide and unfocused, tongue fat and tender, pale white and slippery, with both hands cold and trembling. This indicated that fatigue and overwork had injured the Spleen, causing Qi-deficiency fever. Initially, if Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) had been used, one or two doses would have sufficed. Due to erroneous medication, the Stomach Yin was depleted initially, and the Middle Qi was severely damaged subsequently. Therefore, Ren Shen (Ginseng Root), Shu Di (Prepared Rehmannia Root), and Bai Zhu (Atractylodes Macrocephala Rhizome) were each prescribed at 1 liang, Fuzi (Prepared Aconite Root) and Pao Jiang (Baked Ginger Rhizome) at 3 qian, Chishi Zhi (Halloysitum Rubrum) and Yuyuliang (Yucheng Ore) and Zhi Gancao (Honey-fried Licorice Root) at 5 qian each. Decocted thickly in a large bowl, taken slowly until one bowl was consumed, the patient fell asleep immediately, waking only between Si hour and Xu hour. Cough, diarrhea, and hypochondriac pain all disappeared, and the patient could consume porridge and drinks. With the stomach Qi gradually opening after taking the previous medicine, Tiaozhong Yiqi (Regulate the Middle and Augment Qi) and methods to generate Metal and nourish Water were used to achieve recovery.
Jian Mou suffered from an internal injury resembling an external contraction, with high fever, occasional slight chills, somnolence, and reluctance to speak. Symptoms were lighter during the day and heavier at night. Someone administered Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root) for dispersal, leading to dryness, thirst, delirium, and anorexia. The pulse was floating and rapid without order, and heavy pressing revealed emptiness, largeness, and weakness. The tongue was tender yellow, with the center scorched and dry. This was an internal injury mimicking an external contraction; mistaken sweating robbed the Stomach Yin, leading to dried fluids and exuberant fire without restraint, transforming into a dryness syndrome. Zuogui Yin (Left Restoring Infusion) added with Shengdi (Rehmannia Root), Danggui (Angelica Sinensis Root), and Baishao (White Peony Root) was given. After two doses, stool passed, and heat subsided. On re-examination, the floating and rapid pulses were gone, but deficient fire remained. The secondary illness had retreated, but the primary illness persisted. Since the initial cause was inherent deficiency of Middle Qi, and the subsequent cause was sudden injury to Stomach Yin, if Yin is not rescued first and Qi is supplemented directly, it establishes banners for unrestrained Yang pathogens and adds stones to the already perishing True Yin. Now that Yang fire has retreated and Yin juices are gradually replenished, the initial symptoms can be eliminated immediately. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Shengmai San (Generate the Pulse Powder) cured it in four doses. (In treating internal injuries, Buzhong Yiqi Tang is often regarded as a divine elixir; this discussion must be revisited repeatedly.)
Xue Lizhai stated: "I naturally prefer quiet sitting and reading. After a long time, I feel lethargic and must take Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Maidong (Ophiopogon Tuber), Wuweizi (Schisandra Berry), and a small amount of wine-fried black Huangbai (Phellodendron Bark) to feel mentally clear and comfortable. Otherwise, I suffer from slight insomnia at night and sour-heat in the inner aspect of the feet. If sleeplessness persists, the inner legs are similarly affected, accompanied by a sensation of tendon contraction in the inner legs, causing frequent shifting of both legs and restlessness. Only extreme exhaustion allows sleep. This is labor injuring Yuan Qi (Original Qi), with Yin fire pouring downward due to deficiency. In the Dingyou year, at age fifty-one, I felt a blockage in the gum fissures, causing distension and discomfort. Severe cases felt like sores in the mouth and tongue, worsening in the late afternoon. Only after prolonged sleep or taking the previous medicine did I find relief. In the Xin Chou year, at age fifty-five, I experienced distension in the gum fissures during the day. One dose of Buzhong Yiqi Tang allowed me to sleep at night. By the Ren Yin year, following the变故 (change/mourning period for parents), although I took the previous decoction during the day, the gum fissures distended at night. Every morning before noon, my teeth and limbs felt slightly healthy, but distension returned in the afternoon. From this, it can be seen that as Qi and Blood decline daily, the treatment method must differ."
Commentary: Xue Lizhai skillfully used Buzhong Yiqi Tang throughout his life. Based on this case where excess appeared below initially, its use was appropriate.
Chai Yuqing treated Jueluo Wuxiang, Sima of Shenyang. Upon invitation to diagnose, he said, "A few days ago, due to catching wind-cold, the condition has not resolved. The pulse shows a pause every two beats, slow with Dai (knotted/intermittent) characteristics. This is not an external contraction, but rather deficiency-cold congealing Qi and Blood. Prescribe Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction)." Wu said, "I lack the strength to use Ginseng; replace it with Yuzhu (Polygonatum Odoratum Rhizome)." This was October 21st. The next day, he reported, "After taking the medicine yesterday, my waist felt stiff; turning requires assistance. I need Ginseng; please purchase some." Thus, 1 qian of Ginseng was used. On the morning of the 23rd, the pulse qi improved slightly, and the original formula was maintained. In the afternoon, both knees became stiff and rigid. He asked someone to apply hot flour compresses, but suddenly felt confused. Upon urgent re-invitation, several physicians claimed it was merely wind-cold, prescribing strong dispersing formulas and intending to administer Dahuang (Rhubarb Root). After these physicians left, Wu said, "How can I trust them? Continue taking my medicine, but please adjust it carefully." Therefore, 1 qian of Ginseng was added to the formula. Until the Winter Solstice, decoctions were stopped, and the original formula was made into pills for regulation, leading to recovery. Had Lord Wu lacked firm trust, preservation would have been difficult.
A friend of Xia Da'er, Chen Yongjie of Suzhou, presented with body heat and delirious speech, unable to clearly recognize people. Lu Zhusan, Taishou of Tiaoxi, invited Chai to diagnose while traveling to Beijing for an official appointment. The pulse was large but empty inside, indicating Yang-deficiency fever. Chai proposed using Renshen (Ginseng Root). Lu was shocked and clicked his tongue, believing it absolutely不可用 (unusable), yet forcefully insisted on following the prescription. After one dose, the body felt harmonious; after three doses, the heat completely subsided. Regulation for over a month led to recovery.
Shaosima Yaeertu traveled to Dezhou accompanying the hunt and fell ill, requesting leave to return to Beijing. A physician administered Xiaoxianxiong Tang (Minor Trap in the Chest Decoction) for one dose, causing immediate supine posture, unconsciousness, and muteness. Another physician administered 3 qian of Renshen (Ginseng Root); spirit recovered slightly, but speech was vague, aversion to food, and insomnia persisted. Invited to diagnose, Yaeertu stated, "I have a chronic Liver disease," and described the previous prescriptions. Palpation of the Left Guan position showed a peaceful pulse, only the Heart position was empty and large. This is a Heart disease, unrelated to the Liver. Suanzao Ren Tang (Ziziphus Seed Decoction) cured it.
The servant of Prefect Zhou suffered from fever, anorexia, and fear of ghosts at night, arising from exposure to rain and eating cold zongzi (sticky rice dumplings) on the road. Chai said, "The pulse shows no stagnation, only emptiness and largeness. As the Classics state, 'Cold affecting the form and cold drinks injure the Lungs; hunger, fullness, fatigue, and labor injure the Spleen.' This is caused by internal injury. I propose using Renshen (Ginseng Root), but considering the price expensive, we use Bian Dou (Lablab Bean), Dangshen (Codonopsis Root), Liujunzi Tang (Six Gentlemen Decoction), added with Pao Jiang (Baked Ginger Rhizome) and Dazao (Jujube Fruit). Several doses led to recovery.
Taishi Zhou Xiyong, before the Dingmao examinations, suffered from fatigue and external contraction, with body heat, prostration, and weakness in both legs. Intending to use exterior-releasing agents, he hesitated. Seeking treatment, the Right pulse was weak and soft, and the Renying (Carotid) pulse was not tight. External contraction was light, internal injury heavy. Treating with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), followed by Yigong San (Extraordinary Assistance Powder) for several doses, the illness resolved, leading to consecutive successes in exams.
Guancha Shen Jiaoyuan, while serving as Shimlang, had a family member return from Shandong to Beijing with fever and anorexia. Shen administered large doses of Yin-nourishing medicines like Shudi (Prepared Rehmannia Root), causing severe vomiting. Seeking treatment from Chai, Chai said, "This is caused by injury to Stomach Qi, not suitable for Yin-nourishing medicines." Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction) cured it.
Zhuzheng Cai Xiuchi, during a festival, suffered from fever, thirst, chest oppression, pure black tongue coating, and delirium. Medical consultation was ineffective for over twenty days. Diagnosis revealed a calm and weak pulse, with no external pathogens. Yin-nourishing medicines were administered for two doses without response. Switching to Liujunzi Tang (Six Gentlemen Decoction) added with Pao Jiang (Baked Ginger Rhizome), one dose showed no effect. Later, Dai Tingfu added 1 qian of Zhi Fuzi (Prepared Aconite Root) and 5 fen of Wuzhuyu (Evodia Fruit). After one dose, sweating occurred, and the chest felt relieved. After two doses, sweating continued, and the chest felt open. Regulation led to recovery. Diseases indeed have such types; one must not be careless.
Lu Yangyu treated Zhu Shaohu, who had been ill for half a year. Initially, due to sexual exhaustion with sweating and food stagnation, after using digestion-promoting medicines, he experienced nocturnal emissions and dizziness. Self-administering Renshen (Ginseng Root) provided slight relief, leading to daily doses of 5 qian or 1 liang, accumulating to several jin. His condition developed spontaneous sweating, body heat, hemoptysis, rebellious phlegm, chest diaphragm discomfort, obstruction feeling in the heart region, intermittent coldness in hands and feet, constant dizziness, occasional blindness, and constipation for six days. Whenever dizzy, drinking Ginseng tea provided slight relief. Palpation revealed the Qi Kou (Radial artery at the wrist) and Guan positions wiry, slippery, and forceful; Left Cun and Guan floating and wiry seeming empty; Chi position soggy and weak. This resulted from Liver constraint-heat, exacerbated by mental worry and sexual exhaustion causing deficiency. Although Renshen (Ginseng Root) addressed the pathology, single and excessive use overly benefited Yang, transforming into fierce fire, which adhered with accumulated phlegm to the Spleen and Stomach, leading to heat binding at the幽门 (Pylorus) and fire rebelling upward, disturbing blood and phlegm. Previously, due to aversion to cold and sweating, heavy curtains and thick quilts were used; now, all were removed. Runzi Wan (Moistening Pill) 3 qian was taken, and externally, honey suppositories were used to remove a basin-full of old fecal matter. Then, 7 fen of Renshen (Ginseng Root), 1 qian each of Guishen (Angelica Sinensis Root) and Yuanzhi (Polygala Root), 1 qian of Zaoren (Ziziphus Seed), and 1.3 qian each of Shanzhi (Gardenia Fruit) and Fushen (Poria with Hostwood) were decocted, adding one cup of Zhuli (Bamboo Sap). After one packet, the chest felt open, and sleep was achieved. Daily taking dozens of Runzi Wan pills moistened bowels, stopped sweating, and gradually reduced cough and hemoptysis. Ten doses brought peace.
Lu Zuyu treated Pan Hongyu, who injured the Spleen through overwork. Spleen deficiency damaged the Lung, causing cough, phlegm, wheezing, slight chills, and slight fever. For over a month, cooling, tonifying, Spleen-strengthening, and digestion-promoting medicines were used, leading to sudden reduction in diet and worsening spirit, leaving barely a breath. Diagnosis revealed widespread skin sores and lice, threads-like pulses in all six positions, faint speech, insomnia at night, and habitual difficulty in defecation. Therefore, Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Beimu (Fritillaria Bulb), Zaoren (Ziziphus Seed), Maidong (Ophiopogon Tuber), and Shengdi (Rehmannia Root) were decocted. Separately, Renshen (Ginseng Root), Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Berry) were made into pills, swallowed at dawn. Daily Ginseng intake was about 4-5 qian. Within a few days, improvement was noted. Subsequently, Gui (Angelica Sinensis Root), Shaoyao (Peony Root), Shengdi (Rehmannia Root), Lianqiao (Forsythia Fruit), and Diyü (Sanguisorba Root) were decocted to wash the abdomen, promoting moist defecation. Regulation for over a hundred days brought peace.
Lu Zuyu treated Zeng Xiangyuan, an additional appointee in the local prefecture, who had insufficient Middle Qi and should take Renshen (Ginseng Root) and [missing character]. One day, shortly after lunch, he ate too many yangmei (bayberries), causing chest discomfort, body heat, dizziness, expectoration, thirst, anorexia, and no bowel movement for three days. Someone used Zhaza (Hawthorn Fruit), Zhizi (Immature Bitter Orange), Qin (Scutellaria Root), Lian (Coptis Rhizome), Houpo (Magnolia Bark), and Erchen Tang (Two Aged Decoction) for three to four doses. One bowel movement occurred, passing several dry stools, but symptoms remained unchanged. Then, Gui (Angelica Sinensis Root), Shaoyao (Peony Root), Zhimu (Anemarrhena Rhizome), Maidong (Ophiopogon Tuber), Zhaza (Hawthorn Fruit), and Qin (Scutellaria Root) were used, causing abdominal fullness and vomiting. Palpation revealed the Left three positions floating, faint, and weak; the Right three positions floating, large, empty, and rapid. He said, "Spleen and Stomach are weak; Qi cannot transport, hence chest diaphragm discomfort and stagnation. Moreover, since he cannot tolerate bitter-cold medicines, how can Qin and Lian be used? The Classic says, 'Treat the deficiency, why ask about the rest?'" Therefore, Liujunzi Tang (Six Gentlemen Decoction) added with Bairdouren (Cardamom Seed), Wei Jiang (Roasted Ginger), and Dazao (Jujube Fruit) was given. Symptoms decreased drastically after two doses. Several doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) led to complete recovery.
A person suffered endless worry and irregular diet injuring the Spleen. Complexion was dark black, especially around the mouth. Heart felt empty like hunger, yet no desire to eat. Breathing was short. He said, "This is Spleen Qi injury. Endless worry causes Spleen stagnation and immobility; irregular diet consumes Spleen Qi, causing insufficiency, allowing Yin Qi to enter Yang regions. The Classic states: 'When Yangming syndrome declines, the face begins to wither,' thus knowing Yang Qi is insufficient." Therefore, Renshen (Ginseng Root), [missing character], Baishao (White Peony Root), Shengma (Cimicifuga Rhizome), Gegen (Kudzu Root), Baizhi (Angelica Dahurica Root), Cangzhu (Atractylodes Lancea Rhizome), Gancao (Licorice Root), Jiang (Ginger), and Zao (Jujube) were used to assist the generating Qi of Yangming, achieving recovery.
Zhu Danxi treated a person who, due to fatigue-induced fever, was given Xiaochaihu Tang (Minor Bupleurum Decoction), Huanglian Jiedu Tang (Coptis Detoxification Decoction - containing Qin, Lian, Zhi, Bai), and Baihu Tang (White Tiger Decoction). This反而 (instead) added phlegm-Qi rushing upward,狂言 (wild speech), inability to recognize people, red eyes looking upward, body like blazing fire, six pulses洪数 (surging and rapid) reaching seven or eight beats per breath, empty upon pressing, Left slightly wiry and Kou (cleft). This was due to Middle Qi deficiency, internal injury from cold-cool substances causing internal fever, compounded by too many bitter-cold medicines, resulting in Yin-excess repelling Yang syndrome. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Jiang (Ginger) and Fu (Aconite) and Dazao (Jujube Fruit) cured it in two doses.
Chen Sansan treated a friend with uneven diet, long-distance travel fatigue, fever, irritability, symptoms resembling Taiyang syndrome. The physician prohibited food. Diagnosis revealed faint speech, no heat on the back of hands, six pulses rapid but soft. This was deficiency of True Qi, not external pathogens. Strongly encouraged consuming porridge, then administered sweet-warm major tonifying medicines. Strictly taking them for several days, heat subsided, and peace was restored.
Chen Sansan treated Madam Xia, aged eighty. Endless worry, coupled with occasional summer bathing, led to fever and headache. Physicians thought it was Taiyang syndrome, prohibited food, and aggressively used dispersing methods. Three days later, gas rose with panting, sweat poured like washing, coma, and syncope occurred. Palpation revealed large but empty pulse. He differentiated, saying, "External contraction fever intensifies on the back of the hand; internal injury fever intensifies on the palm. External contraction headache is constant; internal injury headache comes and goes. (Key points for differentiating internal and external injuries should be studied carefully.) Now, headache pauses, and back of hand is not hot, indicating deficiency." Therefore, Renshen (Ginseng Root) and [missing character] each 5 qian, Baizhu (Atractylodes Macrocephala Rhizome) and Banxia (Pinellia Tuber) each 2 qian, Juhong (Citrus Peel) 1 qian, Gancao (Licorice Root) 6 qian were given. Symptoms halved after one dose; doubling Renshen and Baizhu led to recovery.
A person near forty years old suffered tidal fever, dry mouth, preference for cold water. Cooling medicines were ineffective. After four or five days, whole body heaviness, immobility, limb rigidity, deafness, delirium, eyes open but unresponsive, six pulses floating, large, and empty. This was extreme depletion of Qi and Blood. Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) with Baishao (White Peony Root) and Dihuang (Rehmannia Root) removed, plus Shu Fuzi (Prepared Aconite Root) administered in one dose. Snoring and phlegm sounds occurred. Some blamed the error of using Renshen (Ginseng Root), [missing character], Rougui (Cinnamon Bark), and Fuzi (Aconite Root). He said, "This medicine attacks the disease; there is no need to worry." Another dose was given. After an hour, he could turn and move. The next day, several doses were advanced, and all diseases quietly healed. This is treatment following the pulse rather than symptoms.
Li Shizhen treated a person who usually drank alcohol. In winter, mourning his mother while exposed to cold, he contracted cold in the Middle Jiao, unable to eat without ginger and garlic. In summer heat, drinking much water, combined with frustration, he developed a painful swelling point in the right waist, radiating to the right hypochondrium up to the chest, requiring lying down. Attacks caused tenesmus, frequent defecation urgency, long and frequent urination. Sometimes acid regurgitation, sometimes vomiting water, sometimes diarrhea, sometimes impotence, sometimes cold extremities, sometimes slight relief with alcohol, sometimes slight relief with heat. Any exposure to cold, cold food, labor, sex, anger, or hunger triggered immediate onset. Once stopped, all symptoms vanished as if healthy. Severe cases had multiple fever episodes. Warm-Spleen, dampness-vanquishing, tonifying, and digestion-promoting medicines provided slight temporary relief but recurrence ensued. This was due to hunger/fullness and labor injuring Original Qi, with Clear Yang trapped and unable to ascend. Shengma Gegen Tang (Cimicifuga and Kudzu Decoction) combined with Sijunzi Tang (Four Gentlemen Decoction), added with Chaihu (Bupleurum Root), Cangzhu (Atractylodes Lancea Rhizome), and Huang [missing character] was decocted and taken. Afterward, one or two cups of alcohol were still consumed to assist. Upon entering the stomach, clear Qi ascended, chest and diaphragm felt fresh, hands and feet warm, head and eyes bright, spirit vigorous, and all symptoms swept away. Each attack was stopped with one dose, extremely effective. If Shengma and Gegen were reduced, or alcohol not consumed, efficacy would be slower. Generally, those with more descending than ascending Qi, weak constitution, and preceding symptoms should all use this medicine with flexible application. (*Compendium of Materia Medica*.)
Xue Lizhai treated Wang Yidao, a school student, whose Original Qi was inherently weak. In Bingwu and Dingwei years, due to examination fatigue, illness accumulated. By December, the disease flared severely: high fever, tears freezing upon exit, red eyes, dark complexion, waving hands and exposing chest, breathing heavy and nearly ceased, pulse surging large and drumming the finger, empty upon pressing, dry tongue feeling like thorns upon touch. This was true internal cold with false external heat. First, Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) was taken. He said, "Having taken this decoction, the pulse should converge for the better." Shortly after, deep sleep occurred. Upon waking, aversion to cold increased clothing needs, and pulse suddenly became minute and thread-like. This was the true image of deficiency-cold. 1 liang of Renshen (Ginseng Root) added with 3 qian of Shu Fu (Prepared Aconite Root), decocted in water, taken in one gulp, brought peace. At night, pulse collapsed again; 2 liang of Renshen (Ginseng Root) and 5 qian of Shu Fu (Prepared Aconite Root) restored health. Subsequently, large doses of Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Guishen (Angelica Sinensis Root), and Zhi Cao (Honey-fried Licorice) regulated him to safety.
A man with fever, irritability, thirst, headache, mistaken sweating, panting, abdominal pain, spontaneous sweating, and delirium. Treated with Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction) added with Fuzi (Aconite Root). Deep sleep occurred, unrousable. Upon waking, all symptoms retreated. Two doses brought peace.
Huang Wuxuan, due to diet and fatigue, suffered fever and chills. Mistakenly using exterior-releasing medicines, spirit became confused, red spots appeared on the chest, pulse surging, rapid, and empty. This was internal injury to Original Qi, not external pathogens. Urgently using warm-tonifying medicines was required. He did not comply, and subsequently died.
Wang Kentang treated his maternal uncle Yu Wenhua, suffering from fever. One physician, noting absence of body pain etc., knew it was not external contraction, and used Pingwei San (Level the Stomach Powder) added with 5 fen of Renshen (Ginseng Root). Heat intensified. (Using Pingwei San was also meaningless.) Another physician arrived, diagnosed, "This is the fault of Renshen (Ginseng Root); urgently induce sweating." Sweating did not resolve it. Yet another physician arrived, diagnosed, "Pathogen entered the interior; Liangge San (Cool the膈 Decoction) should purge it." Decoction prepared, about to take, Wang arrived, urgently stopped him. Palpation revealed six pulses all surging, large, beating against the finger, forceful on lifting and pressing. Laughing, he said, "This is why the physicians erred." Use Fuling Buxin Tang (Poria Nourishing Heart Decoction) added with 6 qian of Renshen (Ginseng Root), 3 qian of Maidong (Ophiopogon Tuber), 1.5 qian of Zaoren (Ziziphus Seed). Having not slept for nine days, taking the medicine led to snoring sleep for a long time, then awakening, illness retreated. Palpation revealed pulse suddenly weak and faint. Prescription formulated: each dose uses 4 qian of Renshen (Ginseng Root), Zaoren (Ziziphus Seed), Fushen (Poria with Hostwood), Guishen (Angelica Sinensis Root), Baizhu (Atractylodes Macrocephala Rhizome), [missing character], Maidong (Ophiopogon Tuber), Chuanxiong (Ligusticum Chuanxiong Rhizome), etc., instructing continuous consumption, then departed. Days later, returned due to difficult urination, instructed to take Daochi San (Guide Out Redness Powder). Next day, heat returned, tongue black as ink, re-invited diagnosis, pulse returned to surging and large. Because medicines taken continuously reduced Renshen (Ginseng Root) by two-thirds, and Daochi San added Huafen (Trichosanthes Root), Shanzhi (Gardenia Fruit), Huangqin (Scutellaria Root), etc., the illness recurred. Urgently ordered 6 qian of Renshen (Ginseng Root) combined with previous medicines in large doses. Tongue color lightened, heat removed, urination cleared. If Liangge San (Cool the膈 Decoction) had been administered, it would certainly be incurable; how can medicines be recklessly thrown?
Ma Yuanyi treated Qiu Dechu, who had accumulated labor and depression, recently suffered excessive grief from losing his mother, resulting in fever and chills, [missing character] rebellion, irritability, thirst, and flushed face like makeup. Palpation of both pulses revealed sinking, minute, and empty qualities.