诊余举隅录
诊余举隅录
提要
本书二卷，清阳湖陈匊生著。名曰诊余举隅者，因读其一案，即可贯通或因寒、或因热，或因虚、或因实之同证各病，所谓举一隅，反以三是也。原书虽有活字本，印行不多，允宜广传。
陈叙
吾宗匊生，以医国之才，守传家之学，脉审枢阖，术受奇胲，垣见一方，争饮上池之水，月为千轴，不私禁要之书，以为两汉意旉。初非信史，三家俞矫，仅属寓言，丹溪辨疑，尚乖通元之旨，高阳伪托，益损叔和之真，非出手编，孰抒心得，于是观缕往迹，昭示来兹，凡夫诊脉处剂之宜，泻下温中之辨，靡不拘元提要，剖毫析芒，本布帛菽粟之言，阐金匮玉机之蕴，将以发挥名理，启导愚蒙，任举一隅，皆贤三反，登之梨枣，将为寿世之谋，辱在枌愉，许附赠言之义，允颐觕知药性，罕读方书，曩在春明，尝婴末疾，赖君和缓，起我膏盲，遂解带以写诚，益推襟而送抱，习闻绪论，具识洲衷。君每诵孙真人之言曰：胆欲大而心欲小，知欲圆而行欲方。自谓生平心知此意，故能披窍导窾，嘘枯吹生。予维君介石贞操，浑金令器，范为士则，赡盎睟之容。学有师承，秉庭闱之训，疑其敦谨，罕识变通，而乃察色觇豪，不差累黍，审同辨异，妙悟循环，游心于虚，独析三停之秘，银手如断，是为九折之良，如用兵而出奇，将由技而进道。固知俞跗治病，不在汤液之间，岐伯论医，别具神明之用。非夫悬壶市枝，胶柱审音，所可絜量短长，较论得失者矣。活人无算，待树苏家丹橘之林，惟我知言，请读毕氏青囊之帙。
岁在丁酉日长至，武进陈允颐叙
柯叙
语云：儒者不为良相，必为良医，以医之治病，与相之治国，同其道也。顾世之习医者多矣，即著为书，亦复汗牛充栋，大都可皆者多而可法者少。医岂易言哉。陈君匊生，为毗陵名下士，早岁讲求医理，既得家传，而加以天资学力，迥非流俗所可同年语。中年客游南北，活人无算，公卿交誉，声名藉甚。予前在津门，获交匊生，孱躯多病，时赖诊治，受惠孔多。今年需次金陵，夏秋之间，得伏暑证，群医皆主燥湿利导，日见其惫。幸值匊生来应乡试，过我一诊，即用滋阴重剂，与诸方迥别。果一服而大效，三四服而豁然。举此一端，其医学之精，已可慨见。出《诊余举隅录》见示，皆其生平所治疑难各证，或温或清，或补或泻，或重剂或轻剂，或用急法或用缓法，或数人同患一症而彼此治各不同，或一人迭患一症而前后治又不同，其临诊也如珠走盘，无呆滞处，其辨症也如镜鉴形，无模糊处，其用药也如称有权，无游移处，其制方也如纲在纲，无松懈处。虽顷刻告危，不难立救，纵累年宿恙，亦可挽回。洵医学中不经见之书，非若他书揣摩影响者所可比也。夫人能通天地入者为名儒广消息寸关尺者为良医，匊生以儒兼医，异日此书一传，有功医道，当非浅鲜，即谓与良相媲美，亦无不可。予虽不知医，而频年亲药饵，亦略窥其门径，用敢赘述数语以谂精于此道者。
光绪二十三年岁在丁酉仲秋月古歙弟受丹柯铬谨叙
自记
诊余偶举一二证引申其说，为王生攸芋（号祖佑）、胞侄晋蕃（号秋坪）等愤悱启发之一助，其痛斥庸腐陋习处，不免言之过甚。余明知过甚而不能自己手言者，盖以医虽小道，人之性命攸关，安危所系，不比寻常细故，可以含混了事，粉饰过场也。至于审症实情，用药要法，参天人之奥，酌今古所宜，则又有医学可观一书。频年作客，未遑删繁就简，一俟订正，即公同好。若兹所录诸篇，不过一隅之举云尔。
阳湖陈廷儒匊生自记于倦游之室
诊余举隅录目次
卷上
春温夹滞证
夏热失治证
冬月伤寒两感证
咳嗽内外因证
腹痛宿证
淋浊新久证
卷下
咽喉虚实证
阴症辨诬证
阳症辨诬证
冰炭异治证
天人参治证
堕胎血热证
产劳辨诬证
小儿急惊证
小儿慢惊证
童劳辨诬证
诊余举隅录卷上
春夏地气上升，秋冬天气下降，人在气交中，一呼一吸，与时消息，间有不和，名曰感冒。病本轻，平人患此，表散和解，便愈。若系虚人，初起施治，即当标本兼顾，于祛邪中，寓扶正法，否则虚虚之祸，变不可言。丁女，余授徒于家，及门梅锦培病感冒，一月后，病势由重转危，一二时流，断为立毙。其家请诊于余。余视之，身热未清，神气已极昏弱，脉象微不可辨，似有若无，时盖胃虚欲脱，非补不治。因急饮以参汤，少顷，又与以米汤，米汤后，再继参汤，更番迭进，一日数次。明日复诊，脉来有神，惟夜不安寐，独参汤外，又用冬地归脾汤，井戒其家曰，饮蓟后，必安睡，安睡后，必大便，防脱，须多备参汤以待。及饮药一时许，果睡，甚酣，夜半，果大便，便时，汗大出，如欲脱状，频饮参汤，得无恙。阅日又诊，身热已退，神识亦清，后以补中益气汤、八珍汤等方，出入加减，温补而痊。或问曰：前医皆云此症不可服参，独先生见之，即知非参不起，何也?余答曰；参之用不用，视症之虚不虚，人惟邪热积滞大实症，误用人参，酿祸最酷，乃世俗鉴此，视人参如砒毒，虽病至虚危欲脱，亦禁服参，未免太愚。夫虚者于参，譬如饥者于食，渴者于饮，实有相需以养，相赖以生之势，惟其人不饥而食，不渴而饮，所以停积为灾。使见停积为灾，遂疑饮食非生人之具，甘饥渴而死，有是理乎。喻嘉言曰：人受外感之邪，必先汗以驱之。惟元气旺者，外邪始乘药势以出。若虚弱之人，药力外行，气从中馁，轻者半出不出，重者反随元气缩入，发热无休，故表药中，必用人参三五七分，稍助元气，为祛邪之主，庶使邪气得药，一涌而出。又曰：伤寒专科，从仲景至今，明贤方书，无不用参，今日单除不用，全失相传宗旨，使体虚之人，百无一活。曾不悟其害，由是而恩，能为虚人必用之药，彼不敢用参者，盍味斯言。
春温夹滞证
冬令寒邪，伏藏少阴，至春寒化为火，发于少阳，由内而出，名曰春温，与伤寒邪由外发不同，昔人治春温，以黄芩汤为主方，若因感受外邪，引动在里伏热，则先辛凉以解新邪，继进苦寒以清里热，缘温邪忌散，不与暴感门同法故也。使误散之，胃汁却尽，症必转危。乙未春，余客上海，凌少遗之母，年近花甲，患春温症，两旬后，身热汗出，谵语神昏，食不进，寐不安，势已垂危，似不可治。来延余诊，切其脉，虚细而疾，望其舌，苔腻而黄。令按胸院，问痛否，闻伊答曰痛，出话声音，颇有清郎之致，外象虽危，中气未败。核脉参症，明是邪入营室，阴液被却，皖中更有积滞未消，用羚羊清营汤加枳实。二剂，热止神清，脉象亦静，惟神疲气弱，不思饮食，改用加减复脉法，二剂，胃气渐苏，神识亦振。再承前方去二冬加黄芪、白术，温补而愈。按春温症，随地有之，上海为多，盖东南地气，温于西北，上海一隅，尤偏于东，至春令木旺，天气与地气，合同疏泄，不能无偏胜之弊。主治者，若知救弊补偏，得其道矣。
夏热失治证
夏至以后，炎暑司令，相火用事，其人伏邪久郁，适随时气暑热，一朝勃发，名曰热病。及早清之，本无大害，特恐拘守六经分证，仍用伤寒法治，势必转重转危。庚寅夏，余客天津，金陵张君卧楼患病二旬，来延余诊。脉浮细而疾，面赤舌赤，目呆耳聋，神昏谵语，身热汗出，烦躁不寐者八日?米饮不进者六日，小便短赤，大便先溏后结，令人按其脘腹，拒不欲按，至少腹，更不能按。明是大热之症，中有结粪，非急为清下不可。因合白虎承气，去川朴、粳米，加元参、花粉、竹叶，芦根为方。井告其仆曰：服药外，恣饮西瓜水。余去，又有医至，虑病久正亏，所药过峻，不敢与服，改用牛黄清心丸法，入夜，猝起发狂，越户，仆地，举室骇然。其仆记予临去时，有恣饮西瓜水一语，即用西瓜取水饮之。神稍定，扶而入。比明，又延余往，见证较昨益危，询知其故，因告之曰：釜底抽薪之法，古人正为此等热症设也，不通下窍，则上中二焦火，清亦无功，余岂不揣病情，轻以猛药与人者。实因势已垂危，不如此则不救，迫于弗得已也。仍用前方加小生地、麦冬，饮药一时许，即安睡，至夜，大便一次，明晨，又大便一次，神识俱清，能进粥饮。即日又诊，比余至，时刚午刻，神识又昏，人谓此必病退正虚之兆，余曰；不然，面色尚赤，脉象尚数，按至少腹，尚有欲拒之状，见证仍实而不虚，神识复昏，实缘乸午二时，阳气极盛，外火引动内火，相因而炽故也。今再服前药一剂，服后，睡如昨，合亦如昨，从此神清，不复昏矣。后去生军、芒硝，专眼石羔、生地等药至六十余剂，每剂羔、地必用两许，并饮西瓜至三石而后痊。夫此症起于五月，重于六月，其为热病明矣。古人治热病，以白虎汤为主，后贤刘河间创议，分三焦投药，以苦辛寒为主，治法具在，乃俗工不知早为之所，致兆焚如，迨势已垂危，又欲救车薪以杯水，名为慎重，实则因循。幸而气血尚充，稍延时日，否则火性至暴，顷刻燎原，虽有卢扁，其及抽薪于釜底耶。
春分以后，地气动面湿胜，秋分以后，天气肃而燥胜，秋燥致病，气分先受，治肺为急，人皆知之。然肺与大肠相表里，其为金也则一。燥从下受，往往大肠液涸，症转为危。辛卵秋，入都应试毕，吾友史怡之遣入持书，邀余往诊，脉象细数，舌微有黄苔而干，大肠燥结，便后脱肛，人见形容瘦弱，以脱肛为气虚，进以补中益气汤加味，遂至异常疼痛，日夜呻吟，安寐既不能，饮食尤少进。余思瘦人多火，此症系伏火为患，现届秋月燥令，燥火二气相井，庚金受灼殊甚，又眼补气之剂，火得补而益炽病安得不剧。因用地冬润肠膏，二剂，大便润，疼痛平，能安睡矣。再用生地黄煎去竹沥姜汁，三剂，诸恙大减，饮食如恒。后又服滋养药，十余服而愈。论脱肛一症，小儿气血未壮；老人气血已衰，或产育及久痢用力过多，每患此疾，《难经》云：大肠与肺相表里，肺藏蕴热则闭，虚则脱，须升举而补之。盖缘气虚不能约束故也。后入宗其议，遇脱肛症，不问何固，率用补中益气汤为主方，岂知治者愈是，病者愈苦。症情百出，安能以一法绳乎。如此症，燥火烁金，非清润不可，若一于升补，邪愈实，血愈枯，后恐变不可测。昔人于大肠燥结门，有气血耗竭，呕逆不食，便如羊矢之戒，岂无所见而云然哉。
冬月伤寒两感证霜降以后，寒邪直入三阴，谓之直中伤寒，治有温热一法，若由三阳传入三阴，谓之传经伤寒，在外为寒，入内为热，按经施治，宜散宜清，而且六经传变，厥名甚多，有巡经传，有越经传，有首尾传，有表里传，其症以表里传为至重，即伤寒两感症也。一日太阳与少阴同病，二日阳明与太阴同病，三日少阳与厥阴同病，以其阴阳俱病，欲汗则有里症，欲下则有表症，来势极重，辨之不早，顷刻害人。故《内经》、仲景皆云必死，并不言所治法。愚窃谓两感症，外寒内热，即冬温症又感重寒而发者，随其邪之轻重，按症施治，未必绝无挽回。吴鹤皋曰：易老制大羌活汤，用羌活、独活、防风，防己。细辛、川芎、白芷、苍术、黄芩、黄连、知母，生地、生草，意谓传经者皆为阳邪，一于升阳发散，滋阴养藏，则两感之浅者，尚或可平。所论与愚意颇合。至乙未冬，余客上海，有茶业王某患伤寒症，身热恶寒，头痛项强，口干烦渴，溺亦便燥，舌苔黄色，脉来浮举则紧，沉按则数，表有寒，里有热，内外邪俱盛，非太阳与少阴同病之两感症乎。余即师大羌活汤之意，用麻黄、紫苏，荆芥。防风以散外寒，用石羔、知母、元参、生地以清内热，又加枳壳、陈皮利其气而为之佐，重剂投之，两服而痊。可知伤寒两感症，即冬温感寒外寒内热症，本无不治，其云必死者，为误治者言之。非谓概不可治也，其不言治法者，欲后入将六经条治之法，融会贯通，权其表里寒热，分缓急而施治，故不复为赘盲也。至六日死三日死之说，亦谓症情危急，图治当连，迟则无及耳，岂真计日待死，绝无法治哉。方书此类正多，不可不思。
Zhen Yu Ju Yu Lu (Excerpts from Medical Consultations)
Abstract
This book consists of two volumes, authored by Chen Juzheng of Yanghu during the Qing Dynasty. The title "Zhen Yu Ju Yu Lu" implies that by studying one case, one can comprehend various diseases presenting with similar symptoms but caused by different etiologies such as cold, heat, deficiency, or excess. This embodies the principle of inferring three corners from one corner (drawing inferences). Although the original work was printed using movable type, the circulation was limited, and it is advisable to disseminate it widely.
Preface by Chen Yunyi
My clansman, Juzheng, possesses talent for governing the state and upholds family traditions in medicine. He examines the pivot and closure of pulse patterns, and his skills are extraordinary. Upon seeing a prescription, he strives to drink from the "water of Shangchi" (a metaphor for acquiring profound medical knowledge), producing thousands of scrolls monthly without hoarding secret texts, aiming to inherit the medical essence of the Han Dynasties. Initially, these were not strict histories; the three schools corrected each other, resembling allegories. Danxi's doubt-resolution still deviated from the旨 (purport) of understanding the primal origin. Gao Yang's forgery further damaged the authenticity of Shuhe (Wang Shuhe). If not personally compiled, who could express genuine insights? Thus, reviewing past records to illuminate future generations, regarding the appropriateness of pulse diagnosis and prescription, the differentiation between purgation and warming the middle, he adheres to fundamental principles, analyzing details meticulously. Based on plain language like cloth and grain, he elucidates the mysteries of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) and *Yuji Zhenzang Lun*. His aim is to expound upon theoretical principles and enlighten the ignorant. By citing one corner, one may achieve wisdom through repeated reflection. Printing this book serves as a plan to benefit the world. I, Chen Yunyi, though familiar only with basic herb properties and rarely reading formula books, once suffered minor ailments in Chunming (Beijing) and relied on your healing skills, akin to Hua Tuo and Bian Que, to recover from critical illness. Thus, I opened my heart to show sincerity and pushed aside reservations. Having heard your preliminary theories, I fully recognize your inner intentions. You often recite Sun Simiao's words: "Courage should be great, caution small; wisdom should be round, conduct square." You claim to have understood this meaning throughout your life, enabling you to open orifices and guide key points, reviving the withered and breathing life into the dead. I perceive your integrity like a stone, your character like unrefined gold, serving as a model for scholars, possessing a pure and radiant countenance. Your learning has a lineage, inheriting family teachings. Seemingly honest and cautious, rarely knowing flexibility, yet you observe complexion and hair follicles with precision, distinguishing similarities and differences, marvelously comprehending cyclical changes. Your mind wanders in emptiness, uniquely analyzing the secrets of the three divisions. Your silver needle hand is decisive, making you a fine physician of nine bends (experienced healer). Like using troops to surprise enemies, you advance from skill to Dao. It is known that Yu Fu treated diseases not merely with decoctions, and Qibo discussed medicine with divine utility. This cannot be measured by those hanging pots in markets or sticking to rigid rules. Countless lives saved, waiting to establish an orchard like Su Jia's red oranges. Only I understand your words; please read Bi Shi's *Qingnang* (Green Bag) manuscripts.
In the year Dingyou, at the Winter Solstice, Chen Yunyi of Wujin wrote.
Preface by Ke Shoudan
It is said: A Confucian scholar who cannot become a good prime minister must become a good doctor, because treating diseases and governing a country share the same principle. However, many learn medicine today, and although books fill warehouses, few are worthy of emulation. Is medicine easy to discuss? Master Juzheng is a renowned scholar in Piling (Changzhou). In his youth, he studied medical principles, combining family inheritance with natural talent and effort, far surpassing common people. Traveling north and south in middle age, he saved countless lives, praised by nobles, becoming famous. Previously in Jinmen (Tianjin), I met Juzheng. Being frail and sickly, I relied on his treatments, receiving much benefit. This year, while staying in Jinling (Nanjing), between summer and autumn, I contracted latent summer-heat syndrome. Other doctors advocated drying dampness and promoting urination, leading to worsening fatigue. Fortunately, Juzheng came for the imperial examination, visited me, and immediately prescribed heavy yin-nourishing agents, distinct from others. Indeed, one dose brought great effect, and after three to four doses, I recovered completely. From this instance, his medical proficiency is evident. He showed me *Zhen Yu Ju Yu Lu*, containing difficult cases he treated in his life. Whether warming, clearing, tonifying, or purging; heavy or light doses; urgent or slow methods. Sometimes multiple patients had the same symptom but received different treatments; sometimes one patient had recurring symptoms with different treatments over time. His clinical approach was fluid like pearls on a plate, without stagnation; his differentiation clear like a mirror reflecting form, without ambiguity; his medication precise like a scale with weights, without hesitation; his formulation structured like a net's mesh, without looseness. Even in critical moments, rescue was immediate; even chronic ailments could be reversed. Truly a rare book in medicine, unlike others based on speculation. One who understands heaven and earth is a great scholar; one who masters cun, guan, chi pulses is a good doctor. Juzheng combines Confucianism and medicine. When this book spreads, it will benefit the medical way significantly, comparable to a good prime minister. Though I do not know medicine well, having taken herbs for years, I glimpse its path. I dare add a few words to inform experts in this field.
In the mid-autumn month of the 23rd year of Guangxu (Dingyou), Ke Chuo, younger brother of Gushu, respectfully wrote.
Self-Record
Occasionally listing one or two cases during free time to extend explanations, hoping to assist Wang Youyu (Zuyou), nephew Jin Fan (Qiuping), etc., in their frustration and inspiration. The harsh criticism of mediocre and corrupt habits may seem excessive. I know it is excessive but cannot stop writing, for although medicine is a minor art, it concerns life and death, not trivial matters to be glossed over. Regarding accurate symptom assessment and essential medication methods, exploring the mysteries of heaven and humanity, considering ancient and modern suitability, there exists another remarkable medical book. As a traveler for years, I lacked time to simplify. Once revised, it will be shared with friends. These recorded pieces are merely excerpts.
Chen Tingru Juzheng self-recorded in the Room of Weary Travel, Yanghu.
Table of Contents
Volume 1
Four Seasons Cold Damage with Deficiency Collapse Syndrome
Spring Warmth with Stagnation Syndrome
Summer Heat due to Mismanagement Syndrome
Autumn Dryness with Rectal Prolapse Syndrome
Winter Month Cold Damage with Dual Channel Involvement Syndrome
Essence and Qi Deficiency Decline Syndrome
Blood and Qi Double Damage Weakness Syndrome
Cough due to Internal and External Causes Syndrome
Cough with Hemoptysis and Large Intestine Fire Syndrome
Wheezing due to Latent Summer-Heat Syndrome
Vomiting and Hiccups due to Deficiency-Cold Syndrome
Reverse Flow and Dysphagia due to Cold-Heat Syndrome
Headache due to Excess Fire Syndrome
Facial Pain due to Deficiency-Cold Syndrome
Heart and Chest Pain due to Deficiency-Cold Syndrome
Abdominal Pain Chronic Syndrome
Lower Abdominal Pain due to Fire Syndrome
Hernia Pain New and Old, Deficiency-Excess Syndrome
Leg Pain Blood-Qi Deficiency-Excess Syndrome
Dysentery Exterior-Interior, Cold-Heat, Deficiency-Excess Syndrome
Diarrhea Yin-Yang, Cold-Heat, Deficiency-Excess Syndrome
Constipation due to Deficiency-Cold Syndrome
Hemorrhoids due to Heavy Heat-Toxin Syndrome
Strangury and Turbid Urine New and Old Syndrome
Spermatorrhea Yin-Yang Deficiency Syndrome
Volume 2
Stroke Yin-Yang Deficiency-Excess Syndrome
Flaccidity due to Damp-Heat Syndrome
Plague and Measles Deficiency-Excess Syndrome
Cholera Yin-Yang, Cold-Heat, Deficiency-Excess Syndrome
Malaria Exterior-Interior, Yin-Yang, Deficiency-Excess Syndrome
Edema Yang-Deficiency, Yin-Deficiency Syndrome
Spontaneous Sweating Yin-Yang Deficiency Syndrome
Night Sweats due to Blood Deficiency (Not Demons) Syndrome
Cold Extremities due to Blood Deficiency Syndrome
Vertigo Yin-Yang Deficiency-Excess Syndrome
Red Eyes Cold-Heat Deficiency-Excess Syndrome
Throat Deficiency-Excess Syndrome
Gum Swelling due to Wind-Fire Syndrome
Refutation of Yin Syndrome Claims
Refutation of Yang Syndrome Claims
Ice and Charcoal Different Treatments Syndrome
Heaven-Human Integrated Treatment Syndrome
Women's Amenorrhea due to Cold-Heat Syndrome
Women's Dysmenorrhea Yin-Yang Syndrome
Women's Metrorrhagia Deficiency-Excess Syndrome
Prenatal Blood Deficiency and Qi Deficiency Syndrome
Miscarriage due to Blood Heat Syndrome
Postpartum Heat-Stagnation Light and Heavy Syndrome
Refutation of Childbirth Exhaustion Claims
Pediatric Acute Convulsion Syndrome
Pediatric Chronic Convulsion Syndrome
Critical Condition after Smallpox in Children
Childhood Consumption Refutation
Fixed Evidence, Flexible Treatment Syndrome
Zhen Yu Ju Yu Lu Volume 1
Four Seasons Cold Damage with Deficiency Collapse Syndrome
In spring and summer, earth qi rises; in autumn and winter, heaven qi descends. Humans exist in the intersection of qi, breathing in and out, changing with the seasons. Occasionally, disharmony occurs, named "Cold Damage" (common cold). The disease is originally mild; for healthy people, exterior-releasing and harmonizing methods cure it. For deficient individuals, treatment at onset must address both root and branch, incorporating support for righteous qi within pathogen-dispelling methods. Otherwise, the disaster of "deficiency inducing deficiency" leads to unpredictable changes.
A female patient, Ding, whose son I tutored, Mei Jinping, contracted cold damage. After one month, her condition worsened critically, predicted to die within one or two hours. Her family requested my consultation. I observed lingering body heat, extreme mental confusion and weakness, and a pulse so faint it was barely perceptible, seeming present yet absent. This indicated stomach deficiency impending collapse, requiring tonification. I urgently administered Ginseng Decoction. Shortly after, rice water was given, followed again by Ginseng Decoction, alternating several times a day. On the next day's follow-up, the pulse regained spirit, but she suffered insomnia at night. Besides Single Ginseng Decoction, I used Dongdi Guipi Tang (Rehmannia and Angelica Spleen-Tonifying Decoction), warning her family: after drinking the medicine, sleep must come; after sleep, bowel movement must occur to prevent collapse. Prepare plenty of Ginseng Decoction. After about an hour of drinking the medicine, she slept deeply. At midnight, she had a bowel movement, sweating profusely as if collapsing. Frequent administration of Ginseng Decoction stabilized her. Another day's consultation showed resolved fever and clear consciousness. Later, using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Bazhen Tang (Eight Treasures Decoction) with modifications, she recovered through warming and tonification.
Someone asked: Previous doctors claimed this syndrome forbids Ginseng use, yet you knew immediately it required Ginseng. Why? I replied: Use of Ginseng depends on deficiency. Only in cases of severe excess heat and stagnation is Ginseng misuse disastrous. Yet, worldly people, fearing this, view Ginseng as arsenic, forbidding it even in critical deficiency collapse, which is foolish. For the deficient, Ginseng is like food for the hungry or water for the thirsty; they rely on each other for survival. Disaster arises only when non-hungry people eat or non-thirsty people drink, causing accumulation. If one sees accumulation disaster and doubts food/drink sustain life, preferring starvation/death, is that logical? Yu Jiayan said: When affected by external pathogens, sweat must first be induced to drive them out. Only with robust primordial qi do pathogens exit via the drug's force. In weak persons, drug force moves outward, but qi collapses internally. Mild cases partially exit; severe cases retreat inward with collapsing qi, causing continuous fever. Thus, in exterior-releasing drugs, 3-5 qian of Ginseng slightly aids primordial qi, acting as the main force to expel pathogens, ensuring pathogens surge out with the drug. He also said: Since Zhongjing, all Ming dynasty formula books use Ginseng. Today excluding it loses transmitted principles, leaving deficient people with no hope. Those who dare not use Ginseng fail to ponder this.
Spring Warmth with Stagnation Syndrome
Winter cold evil hides in Shaoyin. In spring, cold transforms into fire, emerging from Shaoyang, from interior to exterior, named "Spring Warmth," differing from Cold Damage where evil emerges from exterior. Ancients treated Spring Warmth primarily with Huangqin Tang (Scutellaria Decoction). If triggered by external pathogen activating latent interior heat, first use acrid-cool to resolve new exterior pathogen, then bitter-cold to clear interior heat. Because warm evil fears dispersal, it differs from acute cold damage methods. Mistaken dispersal exhausts stomach fluids, turning critical.
In spring of Yiwu year, I stayed in Shanghai. Mother of Ling Shaoyi, nearly sixty, suffered Spring Warmth. After twenty days, body heat, sweating, delirium, coma, loss of appetite, and insomnia occurred, appearing critical and untreatable. She sought my consultation. Pulse was deficient, thin, and rapid. Tongue coating was greasy and yellow. Pressing chest/epigastrium caused pain. Voice was clear despite critical appearance, indicating middle qi undamaged. Correlating pulse and symptoms, evil entered Ying level (Nutritive Level), yin fluids depleted, and stagnation remained in epigastrium. Used Lingyang Qingying Tang (Antelope Horn Clearing Ying Level Decoction) plus Zhishi (Immature Bitter Orange). Two doses stopped fever and cleared spirit; pulse calmed. Only fatigue and weakness remained with poor appetite. Changed to Jiawei Fumai Fa (Modified Pulse-Recovering Method). Two doses revived stomach qi and spirit. Continuing previous formula, removing Er Dong (Tian Dong and Mai Dong), adding Huangqi (Astragalus) and Baizhu (Atractylodes), she recovered with warming tonification. Note: Spring Warmth occurs everywhere, mostly in Shanghai. Southeast earth qi is warmer than northwest. Shanghai, leaning east, in spring when wood qi flourishes, heaven and earth qi jointly disperse, inevitably causing imbalance. Physicians knowing how to correct bias find the right way.
Summer Heat due to Mismanagement Syndrome
After Summer Solstice, intense heat commands, Minister Fire operates. If latent evil stagnates long, coinciding with seasonal summer heat, it erupts suddenly, named "Heat Disease." Early clearing causes little harm. Fear lies in rigidly adhering to Six Channels differentiation, using Cold Damage methods, inevitably worsening to critical.
In summer of Gengyin year, I stayed in Tianjin. Mr. Zhang Wolou from Jinling sick for twenty days. Pulse floating, thin, rapid. Red face and tongue. Dull eyes, deafness. Coma, delirium. Body heat, sweating, irritability, insomnia for eight days. No rice drink for six days. Scanty dark urine. Diarrhea initially, then constipation. Refused abdominal palpation, especially lower abdomen. Clearly a major heat syndrome with fecal impaction, requiring urgent clearing and purging. Combined Baihu Chengqi (White Tiger and Major Purging), removed Chuan Po (Magnolia Bark) and Jing Mi (Rice), added Yuan Shen (Scrophularia), Huafen (Trichosanthes Root), Zhuye (Bamboo Leaf), and Lugeng (Reed Rhizome). Told servant: Drink watermelon juice freely besides medicine. Another doctor arrived, fearing prolonged illness weakened righteous qi and my drugs were too harsh, refused them, using Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pills). At night, sudden madness, jumping out window, falling down, terrifying everyone. Servant remembered my advice to drink watermelon juice, did so. Spirit settled, helped inside. Next morning, condition worse. I explained: Removing firewood from under the pot (treating root cause) is for such heat syndromes. Without opening lower orifice, upper/middle jiao fire clears ineffectively. I didn't recklessly use strong drugs; situation was critical, requiring this to save life. Still used previous formula plus Xiaoshengdi (Small Rehmannia) and Maidong (Ophiopogon). After one hour, slept peacefully. Night: one bowel movement. Next morning: another. Spirit clear, able to eat porridge. Same day consultation: Just arrived at noon, spirit confused again. Others thought this meant disease retreating and righteous qi deficiency. I said: No, face still red, pulse still rapid, lower abdomen still resists pressure. Symptoms remain excess, not deficiency. Spirit confusion due to extreme yang qi at noon (11 am-1 pm), external fire triggering internal fire, intensifying together. Take one more dose. Sleep and recovery like yesterday. Spirit clear thereafter. Later removed Sheng Jun (Raw Rhubarb) and Mangxiao (Mirabilite), focusing on Shigao (Gypsum) and Shengdi (Rehmannia) for over sixty doses. Each dose used approx. 1 liang of Gypsum and Rehmannia. Drank three shi (unit of volume) of watermelon before recovery. This started in May, worsened in June, clearly Heat Disease. Ancients used Baihu Tang (White Tiger Decoction) as main. Liu Hejian later proposed dividing by Three Jiao, using bitter-acrid-cold. Methods exist, but vulgar practitioners delay, causing burning disasters. When critical, trying to save burning firewood with a cup of water is called prudence but is actually procrastination. Luckily qi-blood still sufficient. Otherwise, fire nature is violent, spreading instantly. Even with Lu Ban (master healers), could they remove firewood from under the pot in time?
Autumn Dryness with Rectal Prolapse Syndrome
After Spring Equinox, earth qi moves, dampness prevails. After Autumn Equinox, heaven qi肃 (solemn), dryness prevails. Autumn Dryness disease affects qi level first; treating Lung is urgent, known by all. Lung and Large Intestine are exterior-interior paired, both Metal. Dryness enters from below, often depleting Large Intestine fluids, turning critical.
In autumn of Xinmao year, after entering capital for exams, friend Shi Yizhi sent letter inviting consultation. Pulse fine and rapid. Tongue slightly yellow coating, dry. Large Intestine dryness/constipation. Post-defecation rectal prolapse. Seeing emaciation, others diagnosed qi deficiency, gave Bu Zhong Yi Qi Tang (Tonify Middle Augment Qi) modified. Resulted in extreme pain, groaning day/night, unable to sleep, eating less. I thought emaciated people have fire. This case involves latent fire. Current autumn dryness command, dry-fire qi combine, Geng Metal scorched severely. Using qi-tonifying agents, fire gets tonified and burns brighter. How can disease not worsen? Used Didong Run Chang Gao (Rehmannia and Ophiopogon Moistening Intestine Paste). Two doses: stool moist, pain ceased, slept. Then Shengdi Jiang (Decoction of Raw Rehmannia) removing Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice). Three doses: symptoms greatly reduced, diet normal. Later took nourishing herbs, cured after ten doses. Discussing rectal prolapse: children's qi-blood not strong; elderly qi-blood declined; childbirth or chronic dysentery straining often cause this. *Nan Jing* says: Large Intestine and Lung are exterior-interior. Lung storing hidden heat causes constipation; deficiency causes prolapse, requiring lifting and tonifying. Because qi deficiency cannot constrain. Later followers adopted this, using Bu Zhong Yi Qi Tang as main for all prolapse, regardless of cause. Ignoring that treatment becomes harder, patient suffers more. Symptoms vary; one method cannot bind them. This case: dry-fire scorches metal, requires clearing/moistening. If solely lifting/tonifying, evil becomes solid, blood dries, future changes unpredictable. Ancients warned in Large Intestine Dryness section: qi-blood exhaustion, vomiting/refusing food, stool like sheep dung. Was this without basis?
Winter Month Cold Damage with Dual Channel Involvement Syndrome
After Frost Descent, cold evil directly enters Three Yin, called Direct Strike Cold Damage, treated with warming-hot methods. If transmitting from Three Yang to Three Yin, called Transmitted Channel Cold Damage. Exterior is cold, interior becomes heat. Treat according to channels, suitable for dispersing or clearing. Six channel transmission names are many: following channel, skipping channel, head-to-tail, exterior-interior. Exterior-interior transmission is most severe, i.e., Cold Damage Dual Channel Involvement. Day 1: Taiyang and Shaoyin simultaneous. Day 2: Yangming and Taiyin simultaneous. Day 3: Shaoyang and Jueyin simultaneous. Both yin-yang diseased. Wanting to sweat reveals interior symptoms; wanting to purge reveals exterior symptoms. Coming trend extremely heavy. Late differentiation harms instantly. Thus *Nei Jing* and Zhongjing say fatal, giving no treatment method. I privately believe Dual Channel Involvement is exterior cold, interior heat, i.e., Winter Warmth contracting heavy cold. Following evil severity, treating by symptoms, perhaps not absolutely incurable. Wu Hegao said: Yi Lao created Da Qianghuo Tang (Major Notopterygium Decoction) using Qianghuo, Duhuo, Fangfeng, Fangji, Xixin, Chuanxiong, Baizhi, Cangzhu, Huangqin, Huanglian, Zhimu, Shengdi, Shengcao. Meaning: Transmitted channel evils are all yang evil. Solely lifting/yang dispersing, nourishing yin/storing, shallow dual channel cases might calm. Discussion aligns with my view.
In winter of Yiwu year, I stayed in Shanghai. Tea merchant Wang suffered Cold Damage. Body heat, aversion to cold, headache, stiff neck, dry mouth, vexation/thirst, scanty urine, dry stool. Yellow tongue coating. Pulse floating tight, deep rapid. Exterior cold, interior heat, both exterior-interior evils abundant. Not Taiyang-Shaoyin Dual Channel Involvement? I followed Da Qianghuo Tang intent: Mahuang, Zisu, Jingjie, Fangfeng to scatter exterior cold; Shigao, Zhimu, Yuan Shen, Shengdi to clear interior heat; plus Zhike, Chenpi to move qi as assistants. Heavy dose administered, cured in two doses.可知 Cold Damage Dual Channel Involvement is Winter Warmth contracting cold, exterior cold interior heat. Originally not incurable. Saying fatal refers to mistreated cases. Not saying universally incurable. Not giving methods wants later generations to integrate Six Channel treatments, weigh exterior-interior/cold-heat, differentiate urgency, thus no need to repeat. Saying death in 3 or 6 days means critical condition requires continuous treatment; delay is futile. Does it mean literally counting days waiting for death with no method? Such cases in formula books are many, must ponder.
Essence and Qi Deficiency Decline Syndrome