钱，入童便服之，得以挽回。
董蔚如侄，饱飧面食，树下纳凉，困倦熟寝，遂头痛身热，骨节烦疼，胸腹否塞。医以丸药下之，表症未
除，胸满兼痛。又行表汗，头痛减，胸痛更甚。或消导，或推逐，其痛渐下，而未得舒畅，几两月。诊得六脉
涩数，面容白黄，舌苔灰黑而润，按其胸腹柔软，脐下坚硬，晡时微热，夜半始退，小水自利，大便不通。此
蓄血症也，乃用桃仁承气汤。服后满腹搅刺，烦躁欲死，其父母哭泣詈骂不可堪，至夜半下黑粪污血若干，遂
腹宽神爽。改用调理之剂而痊。
叶能甫，七月患内伤外感之症，或用煎剂解表，丸药攻里，遂泻数次，而胸闷口干，潮热谵语，舌上黑苔，
手足厥冷。脉之，左三部沉细而涩，右寸关沉滑，尺脉空虚。此阳症见阴脉也，若再一泻，必然不治。乃用陈
皮、甘草、山楂、柴胡、木通、泽泻、浓朴、炮姜，先温消分利，三剂后竟不泻矣。但两手俱沉实，改用黄连、
枳实、山楂、黄芩、浓朴、栝蒌。五六剂，忽转矢气，投润字丸二钱。少顷，去燥矢三二次，前症悉除。遂投养
血健脾之药，调理一月而安。附润字丸方∶橘红一两，杏仁二两，牙皂一两，前胡、天花粉、枳实、山楂肉
各二两，甘草三钱，槟榔七钱，半夏一两，生大黄十二两，水泛为丸。
易思兰治王孙章湖，壮年。七月间，秋收忙迫，饥食二鸡子，酒数杯，时因恼怒，至暮风雨大作，又当风
沐浴，夜半，身热寒战，腰背脊强，胸满腹痛，医用五积散发汗，身凉战止。惟头额肚腹大热，又服柴芩汤，
半月不愈。大便欲去不去，每出些须，实时作痛，又用大黄下三五行。病仍不减，反加胃寒吐逆，饮食入口即
吐，吐时头汗如雨，至颈而还，四肢或厥冷，或发热，大便一日二三次，小便如常，饮食不进者四十余日，亦
不知饥，形瘦日甚。诊之，左手三部俱平和无恙，惟大肠与脾胃脉俱沉紧，按之则大，时一结，坚牢有力，推
之不动，按之不移，曰∶此气裹食积也，下之则愈。先以紫霜丸二十一粒，温水送下。二时不动，又进七丸，
约人行三五里，腹始鸣，下如血饼者五六块，血水五七升。随腹饥索食，以清米饮姜汁炒盐少许一二杯与之，
神气顿生。次日复诊，右寸关脉豁然如左，以平胃合二陈汤，日服一剂。复用补中益气汤加麦冬、砂仁，侵晨
服六味丸，调理一月而愈。其父洪山问曰∶吾儿病外感内伤兼有，医用汗药已愈，但胸腹痛甚，及下后反增胃
寒，见食即吐，是下非所宜矣，何以复下而愈？易曰∶有见于脉耳。左手三部和平，是无外症。右手寸关沉紧
而结，坚牢不动不移，《脉诀》云∶下手脉沉，便知是气，沉而有力者为积，沉紧为寒为痛。自脉断之，阳明当
有坚积也。书又云∶食积发热，夜热昼凉，头额肚腹最甚。胃中积热，蒸蒸头汗，至颈而还。自外症观之，阳
明有积甚明矣。洪山曰∶先生论积固当，何以前用小承气，反加胸闷不食耶？易曰∶此病先因气裹饮食，后复
外感风寒，当日若用香苏散一剂，有紫苏叶散去表寒，有香附、陈皮内行气滞，表解食消，岂不两全？乃用五
积散，虽有麻黄散寒，而当归等药又补住食积，故胸腹愈痛。至于大小承气，尤为未当。小承气去胃中之邪热，
大承气去阳明之燥粪，此症非邪热燥粪。盖邪热燥粪，乃寒自表入里，积热之毒，搏结阳明大肠中原有之粪，
成块成燥，必遇大黄之寒，而邪热始散，得朴硝之咸而坚积始熔，此大小承气之治也。此症乃有形之物，自外
得之者，且鸡蛋性冷而滞，食时遇恼，为气所裹，又加以沐浴受寒，气与食在内，寒邪在外，包裹坚固，其势
有不易消者。夫欲解散寒邪，消化食积，非温热之药不可。食得热则行，得冷则凝。今不用温热，反以寒凉治
之，则寒势愈滋，食积愈坚，胸膈愈满矣。紫霜丸，有巴豆霜之大热以化寒凝，杏仁之辛热以破痰气，代赭石、
赤石脂之重坠以镇定脏腑真气，兼之巴霜之气走而不守，何虑坚不化，积不除耶？
张令韶治孝廉项恂如，秋患伤寒。用发散二剂愈甚，又二剂，神昏不语，大热。诊之，六脉已脱，急用人
参、 、术各一两，附子三钱，姜、桂各二钱。午后，脉渐出，更进六七剂，而病如故，更加舌肿唇烂，
渴饮汤水不绝。（如何犹不入熟地？）曰∶病是此病，药是此药，服之反甚，得无误乎？细审不瘥，又数剂仍如故，十
余日总不能言，其子终恳治。曰∶药已至矣，病终不转，殆死症也。更用八味丸全料，浓煎六碗，冰冷与之，
一日夜服尽，舌肿即消，能语识人。每日用药一剂，粥食数碗，佐之以火肉白鲞 鱼之类，大便不行听之。将
一月，腹始胀，食后更甚，乃以参、苓、 、术、姜、桂、附，煎汤去渣，加大黄二钱。服后，额上微汗出，
手足躁扰不安。此正气虚极也，又与大料温补，一剂遂安卧，夜间下宿垢半桶，饮食如故，后用温补百余剂而
愈。共食人参五斤余，附子三十余枚。后稍失调理，便发热，脱落下颏，直至次年夏间始康健。
钱太庵，同道也，五月间患伤寒，十余日热不退，泄泻一二次。或用炮姜、白术等而泻止。忽发狂、谵语、
大渴，改用荆芥、防风、蝉蜕、红花、笋尖、连翘等，更加昏谵，欲饮冷水。脉之散大，斑色淡而隐隐不明，
曰∶此手少阴心之脉也，由劳心过度，真火虚极，神气外浮，故现此假症，不可以斑治，少顷必发狂。遂用人
参、 、术各三两，茯苓、麦冬、附子各六钱，五味子三钱，分为三剂。煎未就，果发狂，人不能制，服一剂
如故，再剂稍定，三剂遂睡。次日复进药如初，神清渴止，斑亦不见，连进二十余剂。每日晡，尚有谵语数句，
幸粥食进，而大便不行。忽一日心中开亮，如开窗见日然，谵语遂已。乃曰∶先生所云手少阴心病，果然也。
或问何以不用姜、桂而止用附子？曰∶干姜入太阴，肉桂入厥阴，附子入少阴。今病乃少阴君火衰微，故宜用
附子也。又少阴下水上火，而主神机出入，凡病足少阴肾水者，虽凶易愈。病手少阴心火者，治得其法，间有
生者，否则十无一生，何也？心藏神，肾藏精，精者有形，神者无形，治有形易，治无形难也。
陈缵先长媳，上年患虚寒之症，调治之而愈。次年七月间，又患发热恶寒之症。诊之，其脉虚，用桂枝、
姜、白术等一剂，次日更大热矣。张曰∶余亦意其大热也。脉之如初，乃曰∶咽喉肿痛，固属火热，亦有虚寒
者。吾不虑其肿痛，而虑其大吐不止也。可多请高明，治之不愈，再来召我。彼见势危，即遍延诸公。皆曰∶
人虽虚弱，而见证如此，固不可太凉，然热药岂可用乎。俱用甘、桔、山栀、麦冬之类，随服随吐，药俱不受，
病转剧。复召张，张曰∶诸公之论极是，但此病却不然也。初予所以辞者，一则再用热药恐不信，二则必有识
此病能用温补者，何必功自吾出也？遂用人参三钱，桔梗一钱五分，甘草、柴胡、桂枝、干姜、附子、炮姜各
一钱，下咽不吐，少顷大寒战，覆以重绵不解。更与二服，复大热数刻，随大汗如雨，睡觉而痛肿俱消。后用
姜、附、 、参、术，二十余剂而愈。
吕东庄治蔡氏妇，病感症，初服疏表降火清痰之剂，半月愈甚。胸胀满痛，用温胆汤及花粉、栝蒌，痰反
急。用理中加肉桂、延胡、二陈、枳壳，痛结不可忍。医谓调补不应，技穷矣。吕谓调补固如是耶，即理中汤
入破气之药，已能益痛。至甘草一味，若蛔动者，便非所宜，故仲景安蛔散去甘草加椒、梅也。病患果向多蛔
症，（凡病吐蛔多由肝火煎厥，乃厥阴病，故名蛔厥，非结也。）乃仍以理中汤去甘草，加白芍三钱，木香
五分，痛减半。脉之细数甚，口渴欲饮水，不能咽，进汤辄吐，手足时热，面时热，额娇红不定，体如燔炭。
此邪火内沸，怒木乘火，
五阳之火，随之上燔，下烁其阴，龙雷飞越，以药激之，阳格于外，伏阴互结而致，（辞繁而多疵病。）遂以
大八味丸作引与之，曰∶得汗病已。黄昏服药即少睡，面红即退为白，顷乃索被。曰∶俟之，大汗至矣。及三鼓，
烦乱异常。至黎明诊之，脉紧数至八九，曰∶汗已泊矣，而虚不能发也。急煎人参一两，用 、术、归、芍、五
味、甘草为佐，饮之汗大至。曰∶未也。次日再服，汗又大至如雨，诸症顿愈。或曰∶前之甘草不宜服，今两
剂俱重用何也？曰∶初胃中气血攻竭，空虚寒凝，故蛔发而痛，得甘则蛔愈昂上，故不可。今得濡润之药，胃
气冲和，蛔头下伏，虽浓煎与之无害也，法可执一哉。
沈凝芝侧室病伤寒，壮热不止，疏散之愈甚，神情昏愦不寐。吕诊之曰∶此感症也，然起于劳倦，不当重
虚其虚。即投以参、术等，得汗，神情顿清。次用地黄饮子，下黑矢，熟寐。惟热未尽退，前方加炙草一钱即
安。继以滋肾养荣等药，调理复初。
吕姊婿劳仲虎，初夏劳倦，又感寒热，口苦。医用重药发散之，后用楂、朴、枳、半、花粉、栝蒌攻其中
热，益苦。吕用滋水清金，神稍清。次日脉之，浮洪而数，语甚遽而收轻，手指时作微胀，曰∶此皆虚象也。
邪未尝入阳明，而先攻之，伤其元气，邪反随而入阳明矣。重虚其虚，愈不能鼓邪外出。今虽稍定，夜必发谵
语，当急以人参救之。适箧中所带不多，只用人参五钱，黄 一两。次日，家人言夜来甚狂乱不安，似不可救。
曰∶无妨，参力不足故耳。时鼓峰在邑，拉之同往。曰∶汗已至矣，何虑为？乃曰∶无庸疑，吾辈在此坐一刻，
待其汗至而别何如？众在犹豫间，因出酒食过午，举杯未尽，内出报曰∶汗大发矣。是夜热退身凉，痰喘悉平。
继用调土之药而起。
林观子治一人，头痛、身热、体痛，伤寒证也。然舌干燥，好沉睡。诊之，脉豁大无伦次，知其劳于房欲，
复感邪也。与补中益气汤入人参一钱五分服之，得汗热减。三日内进八剂，渐起食粥而安。初服彼甚疑之，见
药入口，必小汗 ，周身和畅，始信而服之。（《伤寒折衷》。）
刘云密曰∶予于癸巳春，因老人气虚，而春每有暴寒，时或冒之，欲疏散而气益虚，遽投参、 而微汗，
邪更不去。将以补益为疏散而用之，又未能却邪。乃用荔枝肉肥浓者五枚，煮酒一盅服之，颇效。又壬寅冬，
癸卯春，予时因微寒，胸膈稍滞，鼻塞不畅，用荔枝浸酒，每日一杯，苏叶、陈皮十分之二，服之数杯后无不
捷效。是则丹溪所谓能散无形质之滞气，诚不虚也。
吴孚先治魏司马夫人，感冒发热，头痛项强，遍身拘急，脉浮紧。医用羌、防、芎、苏等发散，毫无汗意。
曰∶浮则紧矣，独不按其沉则涩乎，且左部尤甚，灼见阴虚血不足，不能作汗也。即以前方加当归、熟地血
药，使云蒸而雨自降。一剂汗如雨，表症悉除。
冯楚胆治常侍卫，据云得之感冒，医以发散，继用凉解，已五六十剂，粒米不进，每日惟饮凉水而已。下
身寒冷而木，渐至胸腹皆冷而实，手足面目肌肉痛痒不知，言语无音，难以布息。按其脉沉微欲脱，令以人参
一两，附子三钱，早晚各一服。服后倘暂有烦躁，无虑也。既而果然。二三日间，渐即相安，脉少起，肢体之
冷，亦非若前之彻骨矣。乃以附子理中汤去甘草，（以胸腹实满也。）早晚各一剂，以温米汤压之。数日后，
冷减，神气稍清，早晨仍服前方，午后以浓参汁冲服，去丹皮加牛膝、杜仲之八味汤。又数日，骨节疼痛不
堪。曰∶此阳回冰解之象也，无复虑矣。复以八味加鹿茸、虎胫、牛膝、杜仲为丸，以加减十全大补汤送之。
两月后，言语始有声，三四月后，始能步履，年余始能鞍马。常患腹痛，后服温暖之剂始愈。
杜中堂子，年十九，夏月病感。脉之，时而洪弦尺弱，时而弦细尺紧。乍寒乍热，（脉随寒热而变也。）
两耳下肿痛，足亦微肿，饮食即吐，静则吐少减，动则吐更甚。询其病由，因偶雨冰雹，骇而出视，背上受寒，
发散和解不效，继用清热之剂，内有黄芩、山栀，服后即发呕矣。盖暑天感寒，中表之气不固可知，况先天
薄弱，膏粱娇养，只宜温中调理，寒邪自散。计不出此，致寒郁火升，两耳之下渐肿及颊，又误以为实火，
济以寒凉，釜底之火既浮，中宫之阳复损，尚堪延纳饮食乎。今欲温中开胃，则耳颊之疼痛为碍，欲滋阴培
本，则中焦之道路不通，计惟有峻补真阳，以达于下，重滋真阴，以继其中。初服八味加牛膝、麦冬、五味，
作大剂冲人参浓汁，服下即吐。改用人参、炮姜、附子为末，以焦白术为膏，略入姜汁和匀为丸，少少参汤
吞服。幸不吐，
顷之腹痛大便，知其气下行，吐可止矣。次日仍以昨煎方，大剂冲人参汤饮之，日用参两余，出入加减渐愈。
后以地黄、归脾二汤间服，遂瘳。
李士材治一人，劳神之后心躁大热，头痛时作时止。医者禁其饮食，与之解表，见四日热不退，欲与攻里。
Qian (patient), (medication) was taken mixed with child's urine, and his life was saved.
Dong Weiru’s nephew, after a heavy meal of wheat noodles, cooled off under a tree, fell into a deep sleep due to fatigue, and subsequently developed headache, fever, painful stiffness in the joints, and chest/abdominal fullness and obstruction. The physician administered pill laxatives; the exterior syndrome remained unresolved, and chest fullness accompanied by pain ensued. Another sweating method was applied; while the headache subsided, the chest pain intensified. Some used digestive methods, others purgative methods; the pain gradually moved downward but never felt relieved, persisting for nearly two months. Pulse diagnosis revealed six pulses that were choppy and rapid. His complexion was pale yellow, tongue coating grey-black yet moist. Palpation of the chest and abdomen showed softness, except for hardness below the umbilicus. He had slight fever at dusk, which subsided at midnight. Urination was normal, but defecation was obstructed. This is Blood Stasis Syndrome (Xue Yu Zheng). Therefore, Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) was prescribed. After ingestion, he experienced severe abdominal twisting and stabbing pain, extreme restlessness bordering on death, causing his parents to weep and curse in despair. By midnight, he passed several stools of black feces and foul blood, after which his abdomen felt loose and his spirit refreshed. A conditioning formula was then used, leading to recovery.
Ye Nengfu, in July, suffered from an internal injury complicated by an external contraction. One physician used decoctions to release the exterior, another used pills to purge the interior, resulting in several episodes of diarrhea. This led to chest oppression, dry mouth, tidal fever, delirious speech, a black tongue coating, and cold extremities. Pulse diagnosis showed the left three positions (cun, guan, chi) as deep, fine, and choppy; the right cun and guan as deep and slippery, while the chi position was empty. This presents as a Yang syndrome manifesting Yin pulses. If purgation continues, it will inevitably be fatal. Thus, Chen Pi (Tangerine Peel), Gan Cao (Licorice Root), Shan Zha (Hawthorn Fruit), Chai Hu (Bupleurum Root), Mu Tong (Akebia Stem), Ze Xie (Alisma Rhizome), Hou Po (Magnolia Bark), and Pao Jiang (Prepared Ginger) were used to first warm the middle, transform accumulation, and separate clear from turbid. After three doses, the diarrhea ceased. However, both hands’ pulses became deep and solid. The prescription was changed to Huang Lian (Coptis Rhizome), Zhi Shi (Immature Bitter Orange), Shan Zha (Hawthorn Fruit), Huang Qin (Scutellaria Root), Hou Po (Magnolia Bark), and Gua Lou (Trichosanthes Fruit). After five or six doses, he suddenly passed flatus. Run Zi Wan (Moistening Pill) was administered. Shortly after, he expelled dry feces two or three times, and all previous symptoms disappeared. Subsequently, blood-nourishing and spleen-strengthening herbs were given, and he recovered after one month of conditioning. Formula for Run Zi Wan: Ju Hong (Exocarpium Citri Reticulatae) 1 liang, Xing Ren (Armeniacae Semen Amarum) 2 liang, Ya Zao (Gleditsiae Spina) 1 liang, Qian Hu (Peucedani Radix), Tian Hua Fen (Trichosanthis Radix), Zhi Shi (Immature Bitter Orange), Shan Zha (Hawthorn Fruit) each 2 liang, Gan Cao (Licorice Root) 3 qian, Bing Lang (Areca Seed) 7 qian, Ban Xia (Pinelliae Rhizoma Preparatum) 1 liang, Sheng Da Huang (Rhei Radix et Rhizoma) 12 liang. Formed into pills with water.
Yi Silan treated Wangsun Zhanghu, a young man. In July, amidst the busy autumn harvest, he ate two eggs while hungry, drank some wine, and often became angry. At dusk, during a storm, he bathed in the wind. By midnight, he developed fever with chills, stiffness of the waist and back, chest fullness, and abdominal pain. The physician used Wu Ji San (Five Accumulations Powder) to induce sweating; the body cooled, and chills stopped. However, the forehead and abdomen remained very hot. He took Chai Qin Tang (Bupleurum and Scutellaria Decoction) for half a month without improvement. He felt the urge to defecate but could not; passing only small amounts caused immediate pain. Da Huang (Rhubarb) was used to purge him three or four times. The illness did not improve; instead, stomach cold and vomiting worsened. Food was vomited immediately upon entry. During vomiting, sweat poured from his head like rain, stopping at the neck. His limbs alternated between cold and hot. He defecated two or three times daily, urinated normally, had no appetite for over forty days, and felt no hunger. His emaciation increased daily. Pulse diagnosis showed the left three positions were peaceful and normal, but the pulses of the Large Intestine and Spleen/Stomach were deep, tight, enlarged upon pressure, occasionally knotted, firm, strong, immovable upon pushing, and unshifted upon pressing. Yi said: "This is food retention wrapped in qi. Purging will cure it." First, Zi Shuang Wan (Purple Frost Pill) 21 pills were given with warm water. After two hours with no effect, seven more pills were administered. After walking about three to five miles, his abdomen began to rumble, and he passed five or six pieces resembling blood clots, along with five to seven sheng of bloody fluid. He then felt hungry and asked for food. He was given a few cups of thin rice gruel with a little fried salt and ginger juice, and his spirit instantly revived. On the next day’s consultation, the right cun and guan pulses had become open and free, matching the left. Ping Wei San combined with Er Chen Tang was prescribed, one dose daily. Then, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Mai Dong (Ophiopogon Tuber) and Sha Ren (Amomi Fructus) was used. Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) was taken early in the morning. He recovered after one month of conditioning. His father, Hongshan, asked: "My son suffered from simultaneous external contraction and internal injury. The physician cured him with sweating agents, but his chest and abdominal pain persisted. After purging, stomach cold worsened, and he vomited upon seeing food. Purging seemed inappropriate. Why did you use purging again to cure him?" Yi replied: "I observed the pulses. The left three positions being peaceful indicates no exterior syndrome. The right cun and guan are deep, tight, knotted, firm, immovable. The *Mai Jue* (Pulse Classic) states: 'When the pulse is deep upon initial palpation, know it is qi stagnation; deep and forceful indicates accumulation; deep and tight indicates cold and pain.' From the pulse, there must be a hard accumulation in the Yangming channel. The texts also state: 'Food retention causes fever, worse at night than day, especially on the forehead and abdomen.' 'Stomach heat retention causes steaming head sweat, stopping at the neck.' Externally, Yangming accumulation is evident. Hongshan asked: "Your analysis of accumulation is sound. Why did using Xiao Cheng Qi Tang (Minor Order the Qi Decoction) earlier worsen chest fullness and loss of appetite?" Yi said: "This illness began with qi wrapping around food. Later, external wind-cold contracted. That day, if Xiang Su San (Fragrant Perilla Powder) had been used—one dose containing Zi Su Ye (Perilla Leaf) to disperse exterior cold, and Xiang Fu (Cyperus Rhizome) plus Chen Pi (Tangerine Peel) to move internal qi stagnation—the exterior would have resolved and food digestion restored. Both goals achieved. Instead, Wu Ji San was used. Although Ma Huang (Ephedra) disperses cold, Dang Gui (Angelica Sinensis) and other tonifying herbs trapped the food retention, worsening chest and abdominal pain. Regarding Da Cheng Qi Tang (Major Order the Qi Decoction) and Xiao Cheng Qi Tang, they were even more inappropriate. Xiao Cheng Qi Tang clears pathogenic heat from the stomach; Da Cheng Qi Tang removes dry feces in the Yangming. This case did not involve pathogenic heat or dry feces. Pathogenic heat and dry feces arise when cold enters from the exterior to the interior; accumulated heat toxins bind with existing feces in the Yangming Large Intestine, forming hard, dry masses. Only with the cold nature of Da Huang (Rhubarb) does the pathogenic heat scatter, and with the salty nature of Mang Xiao (Mirabilite) does the hard accumulation melt. That is the treatment principle for these formulas. Here, the pathogen is a tangible object acquired externally. Eggs are cold and cloying. Eating them while angry meant the qi wrapped around the food. Bathing in the wind added cold. Qi and food were inside, cold pathogen outside, tightly bound, making dissolution difficult. To resolve cold and digest food, warm-hot herbs are essential. Food moves with heat, congeals with cold. Using cold-cool herbs now increases cold and hardens the food retention, increasing chest fullness. Zi Shuang Wan contains Ba Dou Shuang (Croton Seed Frost), extremely hot, to transform cold coagulation; Xing Ren (Apricot Seed), acrid and hot, to break phlegm-q stagnation; Dai Zhe Shi (Hematitum) and Chi Shi Zhi (Halloysitum Rubrum), heavy and sinking, to stabilize the true qi of the zang-fu. Combined with the moving nature of Ba Dou, why worry about hardness not melting or accumulation not removing?"
Zhanglingshao treated Xiaolian Xunru, who contracted Cold Damage (Shang Han) in autumn. Two doses of diaphoretic herbs made him worse; two more doses led to unconsciousness, muteness, and high fever. Pulse diagnosis showed the six pulses had vanished. Urgently, Ren Shen (Ginseng Radix), Gan Jiang (Dried Ginger), Bai Zhu (Atractylodis Rhizoma) each 1 liang, Fu Zi (Aconiti Lateralis Radix Preparata) 3 qian, Sheng Jiang (Fresh Ginger) and Rou Gui (Cinnamon Bark) each 2 qian were administered. By afternoon, the pulse gradually returned. Six or seven more doses were given, but the condition remained unchanged, with additional swelling of the tongue and ulceration of the lips, and incessant thirst for warm liquids. (Why not add Shu Di Huang (Rehmanniae Radix Preparata)?) Zhang said: "The disease is this disease, the medicine is this medicine. Taking it makes it worse. Could there be an error?" Careful examination showed no improvement. Several more doses yielded the same result. For over ten days, he could not speak. His son finally begged for treatment. Zhang said: "The medicine has reached its limit, the disease does not turn. It is likely a terminal case." He then prescribed the full formula of Ba Wei Wan (Eight-Ingredient Pill), decocted strongly into six bowls, served cold. Taken within one day and night, the tongue swelling subsided, and he could speak and recognize people. One dose daily was continued, along with several bowls of porridge, supplemented with roasted meat and dried fish. Defecation was allowed to proceed naturally. After nearly a month, his abdomen began to distend, worse after eating. Then, Ren Shen (Ginseng Radix), Fu Ling (Poria), Gan Jiang (Dried Ginger), Bai Zhu (Atractylodis Rhizoma), Sheng Jiang (Fresh Ginger), Rou Gui (Cinnamon Bark), and Fu Zi (Aconiti Lateralis Radix Preparata) were decocted, strained, and Da Huang (Rhubarb) 2 qian was added. After ingestion, slight sweat appeared on his forehead, and his limbs restless. This indicates extreme deficiency of healthy qi. A large dose of warming-tonifying herbs was given. After one dose, he slept peacefully. At night, he passed half a bucket of old fecal matter. Appetite returned. Over a hundred doses of warming-tonifying herbs were used for recovery. He consumed over five jin of Ren Shen (Ginseng Radix) and over thirty pieces of Fu Zi (Aconiti Lateralis Radix Preparata). Later, slight neglect of conditioning led to fever and mandibular dislocation, recovering only by the following summer.
Qian Tai'an, a colleague, contracted Cold Damage in May. Fever persisted for over ten days, with one or two episodes of diarrhea. Pao Jiang (Prepared Ginger) and Bai Zhu (Atractylodis Rhizoma) stopped the diarrhea. Suddenly, he became manic, delirious, and extremely thirsty. Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Chan Tui (Cicadae Periostracum), Hong Hua (Carthami Flos), Sun Jian (Bamboo Shoot Tip), Lian Qiao (Forsythiae Fructus) were used, worsening confusion and delirium, with a desire to drink cold water. Pulse was scattered and large. Macules were faint and indistinct. Zhang said: "This is the pulse of the Hand-Shaoyin Heart channel. Due to excessive mental labor, the True Fire is extremely deficient, and the Spirit floats outward, presenting these false signs. Do not treat the macules; he will soon go mad." Ren Shen (Ginseng Radix), Gan Jiang (Dried Ginger), Bai Zhu (Atractylodis Rhizoma) each 3 liang, Fu Ling (Poria), Mai Dong (Ophiopogon Tuber), Fu Zi (Aconiti Lateralis Radix Preparata) each 6 qian, Wu Wei Zi (Schisandrae Fructus) 3 qian were divided into three doses. Before decoction finished, he indeed went mad, uncontrollable. One dose had no effect; the second slightly calmed him; the third induced sleep. The next day, medication resumed. Clarity of spirit, cessation of thirst, and disappearance of macules followed. Over twenty doses were continued. Each dusk, he muttered a few delirious sentences, but since he could eat porridge and had no bowel movement, it was noted. Suddenly, one day, his mind cleared like opening a window to see the sun, and delirium ceased. He said: "The Master’s diagnosis of Hand-Shaoyin Heart disease was correct." Someone asked: "Why use only Fu Zi (Aconiti Lateralis Radix Preparata) and not Gan Jiang (Dried Ginger) or Rou Gui (Cinnamon Bark)?" Zhang replied: "Gan Jiang (Dried Ginger) enters the Foot-Taiyin Spleen; Rou Gui (Cinnamon Bark) enters the Foot-Jueyin Liver; Fu Zi (Aconiti Lateralis Radix Preparata) enters the Hand-Shaoyin Heart. Now the disease is deficiency of the Ministerial Fire of the Hand-Shaoyin, so Fu Zi (Aconiti Lateralis Radix Preparata) is appropriate. Furthermore, the Shaoyin governs Water and Fire, controlling the mechanism of Spirit. Diseases of the Foot-Shaoyin Kidney Water, though severe, are easier to cure. Diseases of the Hand-Shaoyin Heart Fire, if treated correctly, may occasionally survive; otherwise, ten out of ten die. Why? The Heart stores the Spirit; the Kidney stores Essence. Essence is tangible; Spirit is intangible. Treating the tangible is easy; treating the intangible is difficult."
Chenzuanxian’s eldest daughter-in-law suffered from deficiency-cold last year, cured by conditioning. In July of the following year, she suffered from fever and aversion to cold. Pulse was deficient. Gui Zhi Tang (Cinnamon Twig Decoction) with Sheng Jiang (Fresh Ginger) and Bai Zhu (Atractylodis Rhizoma) was given for one dose. The next day, fever intensified greatly. Zhang Jingyue said: "I anticipated great fever." Pulse remained the same. He said: "Throat swelling and pain usually belong to Heat, but can also be Deficiency-Cold. I do not worry about the swelling/pain, but fear incessant vomiting. Invite other physicians. If they fail, summon me." Seeing the danger, many doctors were invited. All said: "Though weak, the signs are such that cooling is inadvisable, but how can hot herbs be used?" They used Gan Cao (Licorice Root), Jie Geng (Platycodon Root), Shan Zhi (Gardenia Fruit), Mai Dong (Ophiopogon Tuber). Vomiting occurred immediately upon ingestion; no medicine was retained. Condition worsened. Zhang was summoned again. He said: "Your discussions are excellent, but this case is different. I declined initially because: 1) Reusing hot herbs might not be believed; 2) There must be someone who recognizes this disease and can use warming-tonification. Why should I take the credit?" Ren Shen (Ginseng Radix) 3 qian, Jie Geng (Platycodon Root) 1.5 qian, Gan Cao (Licorice Root), Chai Hu (Bupleurum Root), Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger), Fu Zi (Aconiti Lateralis Radix Preparata), Pao Jiang (Prepared Ginger) each 1 qian were prescribed. No vomiting occurred upon swallowing. Soon, severe chills ensued, covered with thick cotton without relief. Two more doses were given. Severe heat followed for a moment, then profuse sweating like rain. Upon waking, pain and swelling disappeared. Ginger, Aconite, Fu Ling (Poria), Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Rhizoma) were used for over twenty doses, leading to recovery.
Lv Dongzhuang treated Lady Cai, suffering from a contraction syndrome. Initial treatment with exterior-releasing, fire-clearing, phlegm-resolving herbs worsened it over half a month. Chest distension, fullness, and pain occurred. Wen Dan Tang (Warm the Gallbladder Decoction) with Hua Fen (Trichosanthis Radix) and Gua Lou (Trichosanthes Fruit) made phlegm urgent. Li Zhong Wan (Regulate the Middle Pill) with Rou Gui (Cinnamon Bark), Yan Hu Suo (Corydalis Rhizoma), Er Chen Tang (Two-Aged Decoction), Zhi Ke (Aurantii Fructus) caused unbearable pain knots. Physicians said conditioning failed, skills exhausted. Lv said: "Conditioning is indeed like this. Even Li Zhong Tang (Regulate the Middle Decoction) with qi-breaking herbs increases pain. As for Gan Cao (Licorice Root), if roundworms are active, it is unsuitable. Hence, Zhongjing’s An Hui San (Roundworm-Calming Powder) removes Gan Cao (Licorice Root) and adds Pepper and Plum.) The patient indeed had frequent roundworm issues. (Vomiting roundworms usually results from Liver Fire frying Jueyin, hence Jueyin disease, named Hui Jue (Roundworm Convulsion), not knotting.) Lv still used Li Zhong Tang (Regulate the Middle Decoction) removing Gan Cao (Licorice Root), adding Bai Shao (Paeoniae Radix Alba) 3 qian, Mu Xiang (Aucklandiae Radix) 0.5 qian. Pain halved. Pulse was fine and rapid. Thirsty for water but unable to swallow; drinking caused vomiting. Limbs and face intermittently hot, forehead flushed irregularly, body burning like charcoal. This is Evil Fire boiling internally, Angry Wood overcoming Fire. The Five Yang Fires follow, scorching upward, consuming Yin downward. Dragon-Lei (Ministerial Fire) flies away. Provoked by medicine, Yang is blocked externally, hidden Yin binds internally. (Explanation verbose and flawed.) Lv gave Da Ba Wei Wan (Large Eight-Ingredient Pill) as a guide, saying: "Sweat will indicate cure." Medicine taken at dusk; slight sleep ensued. Red face turned white, then requested blankets. Lv said: "Wait, profuse sweat is coming." By midnight, extreme restlessness. Dawn pulse: tight and rapid, 8-9 beats. Lv said: "Sweat has stopped, but deficiency prevents emission." Urgently, Ren Shen (Ginseng Radix) 1 liang, Gan Jiang (Dried Ginger), Bai Zhu (Atractylodis Rhizoma), Dang Gui (Angelica Sinensis), Bai Shao (Paeoniae Radix Alba), Wu Wei Zi (Schisandrae Fructus), Gan Cao (Licorice Root) were decocted and drunk. Profuse sweat ensued. Lv said: "Not yet." Next day, another dose. Sweat again like rain. All symptoms vanished. Someone asked: "Gan Cao (Licorice Root) was unsuitable before; why heavily used in both recent doses?" Lv said: "Initially, stomach qi and blood were exhausted, empty and cold-congealed, causing roundworm activity and pain. Sweetness makes roundworms rise higher, hence contraindicated. Now, with moistening herbs, stomach qi is harmonious, roundworm heads settle down. Heavy decoction is harmless. Can rules be rigid?"
Shen Ningzhi’s concubine suffered from Cold Damage. Unremitting high fever. Exterior-releasing worsened it. Spirit confused, insomnia. Lv Dongzhuang diagnosed: "Contraction syndrome, arising from fatigue. Do not severely deplete deficiency." Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Rhizoma) were given. Sweating occurred, spirit cleared. Di Huang Yin Zi (Rehmannia Decoction) was used next. Black feces passed, deep sleep ensued. Fever not fully resolved. Zhi Gan Cao (Honey-fried Licorice Root) 1 qian added to previous formula brought peace. Zi Shen Yang Rong (Nourish Kidney and Enrich Ying) herbs conditioned her to recovery.
Lv Dongzhuang’s brother-in-law, Lao Zhonghu, fatigued in early summer, contracted cold-heat, bitter taste. Physician used heavy diaphoretics. Then Shan Zha (Hawthorn Fruit), Hou Po (Magnolia Bark), Zhi Shi (Immature Bitter Orange), Ban Xia (Pinelliae Rhizoma Preparatum), Hua Fen (Trichosanthis Radix), Gua Lou (Trichosanthes Fruit) attacked middle heat, worsening bitterness. Lv used Zi Shui Qing Jin (Nourish Water and Clear Metal). Spirit slightly cleared. Next day pulse: floating, surging, rapid. Speech hurried, withdrawal light. Fingers occasionally slightly swollen. Lv said: "All deficiency signs. Pathogen did not enter Yangming, yet attacked first, damaging Yuan Qi. Pathogen followed into Yangming. Severely depleting deficiency makes expelling pathogen harder. Though slightly stable now, delirium will occur at night. Urgently use Ren Shen (Ginseng Radix) to save him." Limited supply in pouch: Ren Shen (Ginseng Radix) 5 qian, Huang Qi (Astragali Radix) 1 liang. Next day, family reported wild unrest at night, seemingly incurable. Lv said: "No harm. Insufficient Ren Shen (Ginseng Radix) power." Gu Feng was in the county, invited to join. Lv said: "Sweat has arrived, why worry?" Said: "Do not doubt. Let us sit here for a moment, wait for sweat, then leave." While hesitating, wine and food were served past noon. Before finishing the cup, report came: "Profuse sweat erupted." That night, fever subsided, body cooled, phlegm-wheezing ceased. Earth-regulating herbs initiated recovery.
Lin Guanzi treated a man with headache, fever, body ache—Cold Damage signs. Tongue dry, deep sleep desired. Pulse vast and chaotic. Known sexual exhaustion, then contracted pathogen. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Ren Shen (Ginseng Radix) 1.5 qian was given. Sweating reduced fever. Eight doses over three days. Gradually rose, ate porridge, stabilized. Initially suspicious, but after slight sweating and whole-body comfort upon ingestion, believed and continued. (*Shang Han Zhe Zhong*).
Liu Yunmi said: "In spring of Gui Si year, due to elderly person’s qi deficiency, and frequent sudden cold in spring, sometimes contracting it. Wanted to release exterior, but qi became more deficient. Hastily gave Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix); slight sweat occurred, but pathogen remained. Tried using tonification as release, yet failed to expel pathogen. Used five fleshy lychees, boiled in one cup of wine. Very effective. In winter of Ren Yin, spring of Gui Mao, due to slight cold, chest/diaphragm stagnation, nasal congestion. Lychee-infused wine, one cup daily, with 20% Su Ye (Perilla Leaf) and Chen Pi (Tangerine Peel). After several cups, always effective. This confirms Danxi’s statement: 'Can dissipate formless qi stagnation,' truly not false."
Wu Fuxian treated Madam Wei Sima. Cold-induced fever, headache, stiff neck, whole-body rigidity. Pulse floating and tight. Physician used Qiang Huo (Notopterygii Rhizoma), Fang Feng (Saposhnikoviae Radix), Xiong (Ligustici Chuanxiong Rhizoma), Zi Su (Perillae Folium) to release exterior. No sweat. Wu said: "Floating and tight, but did you check deep? Deep is choppy, especially on the left. Clearly Yin deficiency and blood insufficiency, unable to produce sweat." Added Dang Gui (Angelica Sinensis) and Shu Di Huang (Rehmanniae Radix Preparata) to the previous formula. Clouds vaporize, rain falls naturally. One dose: sweat like rain, exterior symptoms resolved.
Feng Chudan treated Guard Chang. Claimed cold-induced. Physician used exterior-release, then cooling-clearance. Fifty-sixty doses. Ate nothing, drank only cold water. Lower body cold and numb, extending to cold/solid chest/abdomen. Hands/feet/face/muscles insensitive to pain/itch. Mute, difficult breathing. Pulse deep, minute, vanishing. Ordered Ren Shen (Ginseng Radix) 1 liang, Fu Zi (Aconiti Lateralis Radix Preparata) 3 qian, morning and evening. If temporary restlessness occurs, do not worry. Indeed happened. Within 2-3 days, gradually stabilized. Pulse slightly rose. Limb coldness less bone-piercing. Fu Zi Li Zhong Tang (Aconite Regulate Middle Decoction) removing Gan Cao (Licorice Root) [due to chest/abdominal fullness], morning and evening, pressed with warm rice soup. Days later, cold reduced, spirit slightly clear. Morning: previous formula. Afternoon: concentrated Ren Shen (Ginseng Radix) juice mixed with Ba Wei Tang (Eight-Ingredient Decoction) removing Mu Dan Pi, adding Niu Xi (Achyranthis Bidentatae Radix) and Du Zhong (Eucommiae Cortex). Days later, unbearable joint pain. Feng said: "Sign of Yang returning and ice melting. No worry." Ba Wei Wan (Eight-Ingredient Pill) with Lu Rong (Cervi Cornu Colla) and Hu Jing (Tigris Ossis) was formed into pills, taken with Jia Jian Shi Quan Da Bu Tang (Modified Ten Complete Tonifying Decoction). Two months later, voice returned. Three-four months later, walking possible. Over a year later, horseback riding possible. Frequent abdominal pain, cured later by warming herbs.
Du Zhongtang’s son, age 19, contracted illness in summer. Pulse: sometimes surging/wiry with weak chi, sometimes wiry/fine with tight chi. Alternating chills and fever. (Pulse changes with chills/fever.) Swelling/pain below both ears, slight foot swelling. Vomiting immediately after eating. Less vomiting when quiet, more when moving. Cause: hailstorm, startled to look, back exposed to cold. Exterior-release and harmonization ineffective. Cooling herbs with Huang Qin (Scutellaria Root) and Shan Zhi (Gardenia Fruit) caused vomiting. Summer cold contraction means middle/exterior qi insecure. Congenital weakness, pampered upbringing. Should warm middle, regulate, cold pathogen self-disperses. Plan failed. Cold depressed, fire rose. Swelling below ears extended to cheeks. Mistaken for excess heat, treated with cold-cool. Fire at pot bottom floated, middle palace yang damaged. How can food intake continue? To warm middle/open appetite, ear/cheek pain hinders. To nourish yin/nourish root, middle jiao pathway blocked. Only峻补真阳 (severely tonify True Yang) to reach below, and重滋真阴 (heavily nourish True Yin) to sustain middle. Initially, Ba Wei Wan (Eight-Ingredient Pill) with Niu Xi (Achyranthis Bidentatae Radix), Mai Dong (Ophiopogon Tuber), Wu Wei Zi (Schisandrae Fructus), large dose mixed with concentrated Ren Shen (Ginseng Radix) juice. Vomited immediately. Changed to Ren Shen (Ginseng Radix), Pao Jiang (Prepared Ginger), Fu Zi (Aconiti Lateralis Radix Preparata) powdered, Jiao Bai Zhu (Charred Atractylodis Rhizoma) paste, mixed with ginger juice, formed into pills. Swallowed sparingly with Ren Shen (Ginseng Radix) soup. Fortunately, no vomiting. Soon, abdominal pain and defecation. Qi moving downward, vomiting stops. Next day, previous decoction, large dose with Ren Shen (Ginseng Radix) soup. Daily Ren Shen (Ginseng Radzi) over 1 liang. Adjustments led to gradual recovery. Later, Di Huang Wan (Rehmannia Pill) and Gui Pi Tang (Restore the Spleen Decoction) alternating, cured.
Li Shicai treated a man. After mental exertion, heart irritability, great heat, intermittent headache. Physician restricted diet, gave exterior-release. Four days fever persisted. Wanted to purge interior.