小便不通，有寒热痰湿气血虚宴之分。惟淋症则多眉于热，寒者绝少，盖热甚生湿，故水液浑浊而为淋也。庚寅冬，余至济南，有徐某来延余诊。据云‘小腹胀满，溺涩不通，日夜涓滴，色赤而浑，病经五年，屡治不效。今夏忽重，入冬尤剧，溺后茎痛，下气上逆，喘急不堪。余切其脉，诸部濡数，惟左关尺数大，按之有力，知病久气血虽亏，膀胱湿热仍盛。遂用人参、芪、术以益气，地黄。黄柏以养阴，制军、甘草以清热，滑石、木通以利湿，僵蚕以化秽，青皮以行气，牛膝以下引，葛根以上升，标本兼顾，随症减增，数十剂而病愈。壬辰夏季，余寓都门，有刘某患浊，日夜淋漓不尽，前茎有筋胀痛，后连肛门，已十余日。余诊之，脉象滑数，知是浊邪正盛，以涤瑕荡秽之峻剂，下紫黑脓血无数，半月而愈。可知淋浊治法，初起即与荡涤，其病易疗，如后症是已。惟恐治不如法，邪气留变，势必频年不愈，如前症然。或问前症治法，余曰：此为复方，方中有阳有阴，有温有清，有补有泻，有降育升，一阎一辟，理最元妙，征之古方，殆东垣清燥汤意乎。在东垣制此汤，所以治体虚夹暑，与一切湿热症，非为淋症设也。然淋至数年，正气已虚，入夏病加，暑邪自盛，溺浑茎痛，湿热尤多，按之清燥汤，治法颇台，余即师其意用之，病果应手而效。惟效后，宜戒酒少劳方妙，否则食复，劳复，甚易事耳，慎之。
肾阴虚则精不藏，肝阳强则气易泄，故遗精惟肾肝为多，然亦有不在肝肾，而在心肺睥胃之不足者，又未可执一论。庚寅冬，余至济南，有黄姓某，五十余岁，精关不固，先遗后滑，病经一年，神疲气弱，痿顿不堪，频服六味丸不效，来延余诊。脉象两尺细数，寸关虚大，知是阳气下陷，不能摄精，以补中益气汤加麦冬、五味，固摄而愈。乙未，余寓上海，宁波沈某二十余岁，形瘦色赤，咳嗽吐红，黎明梦遗，患已两年，医药不应，间治于余。余诊之，六脉滑数，左尺尤盛，知是阴虚有火，用六味丸去山萸、加元参、黄柏、车前，十剂，火平。又十剂，阴复。仍前法进以参、芪，调养而愈。此：二症也，前系脾阳虚，后系肝阴虚，皆不足症也。然一阴一阳，判若霄壤。如当升补而反滋阴，元气愈陷，如当滋清而反补涩，相火愈强。不辨所固，谬然施治，病必加剧。又况郁滞积热，与一切痰火为病，每致不梦而遗，尤非聚精固精等丸所能奏效乎。总恃临诊者，有辨虚实审阴阳之权耳。
中风，有偏枯，有风痱，有凤懿，有风痹。治法，以气与血为本，外邪为标。乙末夏，柳君耔青自镇江至上海，中途劳乏，汗出遇风，卒中于阴，右偏臂脐无力举持，舌筋亦短而蹇于言，前医投以清疏药，不合，杨省臣太守代邀余诊。切其脉，右缓无力，知是肥人气虚，外卫不固，以独活汤、干金附千散、黄芪建中汤等方，出入加减，调治而愈。丁酉春，余客天津，吴桥王检予大令患偏中风，以车速余往诊。右偏面肿，口㖞言蹇，手不住持，足不任步，膝胫畏冷入骨，食不甘，寐不安，烦躁尤甚。切其脉，左盛右微，望其苔，右厚左薄，谂是劳倦内伤，风寒外感所致。用黄芪附子建中汤、防风散、桑菊煎出入加减为方，两旬余而愈。此皆阳虚，以阳药效者也，然又有阴虚，当以阴药效者。庚寅春，余至天津，刘稼民观察病中风两日，来延余诊。食不进，语不出，神昏气粗，两目上视，手足右尚能动，左已不举。切其脉，滑大而数，知是阴虚阳盛，木火挟痰火，两相鼓煽所致。治以清火豁痰平肝熄风之剂。明日复诊，神识清，已起坐。仍前方，佐以益阴补气法，月余，饮食如恒，渐能步履，大可望愈。后余以事他适，路隔较远，其家另延他医，专任温燥药。绵延两月，阴气销亡，小便频数，夜更无度。此时急救其逆，征之古方，当用六味丸如五味子，而他医畏用地黄，不敢与服，病竞不起。噫，人之死生有定数，药之宜忌所当知。地黄一味，有生用者，有焙干用者，有以法制熟用者，《本经》主治，实多散血凉血补血之功，故云久服轻身不老，并尊之为药中上品。世俗不察，以生地为滑肠，熟地为泥膈，视如砒毒，亦谬其矣。夫用生地而滑肠，乃胃弱气虚之故，用熟地而泥膈，乃痰多气窒之由，此皆不明虚实使然。古方导赤散，以生地黄与木通同用，泻丙丁之火；琼玉膏、固本丸、集灵膏，以干地黄与人叁二冬并用，治血劳喘嗽唾血，六味丸、八味丸、四物汤，均以熟地黄为君，盖熟地能填骨体，长肌肉，生精血，补五藏内伤不足，与病后胫股酸痛，坐而欲起，目（目，流-氵）（目，流-氵）如无所见等症，功用非浅小矣。乃后人又泥张石顽之说，谓地黄性禀阴柔。如乡愿然，似是实非，似是实非，似利实害，虽病至阴虚火旺，五劳七伤，亦不敢用，岂知石顽之说，犹言生地防滑畅，熟地防泥隔，欲人明辨用之，非屏地黄于无用之地也。王好古曰：生地黄治心热，益肾水，其脉洪实者宜之。若脉虚者宜熟地黄，如此明辩其义，则地黄一味，无往不受其益矣。
痿由肺热，传入五藏，热蒸则湿郁，气机为之不利，与风病外感，善行数变者不同。乙未，余寓上海，刘君润甫之室，病起夏秋，缠绵数月，偃息在床，起坐无力，手足软弱，不任举持，来延余诊。切其脉，大而滑，知是夏令湿热，蕴久不化，气分受伤，致成痿症，与草木在暑日中，热气蒸灼，枝叶皆痿软下垂无异，非得夜来清气涵濡，则生气必不能勃然。遂用清燥汤法，加减治之，月余而症悉愈。丁酉，余客天津，夏初，潘黎阁观察，为其孙缙华病久不愈，来速余诊。据云，患已数月，延今，手足心热，盗汗不止，胸胁胀闷，抽搐作痛，两腿酸不任地，痿弱如废。余切其脉，寸关虚缓，尺部滑实，知是上盛下虚之假象，当舍证从脉，作上虚下盛治。用补中益气汤、部芩五苓汤等方，出入加减治之，两旬余而愈。论二症治法，即前哲泻南方补北方之意也。然或以泻为补，或以补为泻，或补与泻两相需，用意时有不同。又况兼食积挟瘀血，痿症常有之。余尝佐以消食浚血诸法，始能奏效。随症论治，岂可以一法尽乎。
痧麻之邪，由阳明府上蒸手太阴经，而又为外寒所遏，故初起必见咳嗽身热等症，用辛平药以治外，滋清药以治内，此大法也。然症有虚实之分，治有标本之别。戊子春，内亲蒋子重病经两旬，来邀余诊。发热无汗，遍体麻粒，哕逆时作，便泄不已，舌苔灰黑，厚腻而干，脉象虚微，按之欲绝，神昏气弱，呼之不应，势甚可危。余思此症，正气虚极，垂脱之时，即有外邪，概从缓治。用高丽参五钱煎汤先饮，并用十全大补汤去茯苓加陈皮、煨葛根为方，大剂投之。两剂，神气稍振，能进稀粥，呕哕便泄亦止，惟身热未清，是外邪不能自达也。仍前方加紫苏，或谓既眼大补药，不当用疏散药，去而服之，身热如故。余曰：病中止虚，补之则安，固不容散。若中虚又有外邪，补与散实两相需，今人不通此理，当补不补，因而当散不散，所以病多棘手。抑知东垣治阳虚外感，用补中汤加表药，丹溪治阴虚外感，用芎归汤加表药，补中寓散，用意最为元妙乎。仍加紫苏等药四味，另煎冲入饮之。一剂，身热减半，再剂，身热始清。即去紫苏，专服大补药，数十剂而病愈。愈后，头面指甲浑身脱下如蜕，所谓灰黑舌苔，亦落下一大片。辛卯春，余客山东，周君申之元室，病痧麻症，前医投以清疏药，不受，饮入仍吐出，来延余诊。身热面赤，胸闷便泄，舌绛苔黄，脉滑而数，令按胸皖，内觉硬痛，知是温邪发外，物滞阻中，前药只可疏邪，不能导滞，所以饮药入内，格而不通，阅时复吐出。仍前医方，加消导药一二味与之。一剂，吐泻止，胸闷宽，再剂，身热清，能进粥饮。后又清养之调朴之，满身皮脱而愈。此二症也，前刚由病致虚，后则由滞致病，随时论症，权其因而治之，病自应手而效。乃世俗不察，气既虚而不知补，胸有滞而不知通，何哉。
霍乱一症，有触冒寒邪者，有感受暑热者，有停滞饮食者。其致病有上下浅深之分，有阴阳虚实之别。来势极速，拟议不及，或吐而不泻，或泻而不吐，或吐泻交作，或欲吐不得吐，欲泻不得泻。治法，既不可专用寒凉，又不可偏用温补，至滋养消导，亦有时而必用。总恃随时论症，随症论治，始能奏效。若拘守成法，不知变通，杀人易于反掌。近年霍乱盛行，死丧频仍，皆呆守成法者误之。戊子，余授徒于家，及门梅诠生之父，夜半患霍乱，医治以来复丹等方，吐泻不止，势甚可危。天甫明，来延余诊。切其脉，细数无伦，面赤舌绛，苔黄而薄，腹痛时作，知是阴虚有火。用复脉汤，易麻仁为枣仁，去桂枝，生姜，加川连、白芍。服后，吐泻即止，渐进粥饮。再仍是方加减，眠食俱安而愈。又同城小河沿郁长生之妇，孕已三月，患霍乱症，来延余诊。脉伏不见，遍体皆冷，惟两肩尚温，此为阴阳两亡。治以回阳为急，重用附子、干姜、高丽参，并加陈皮、炙草为方。一剂，遍体转温，惟足扰冷。再剂，两足亦温，能进粥饮。此时阳气偏胜，当顾其阴，去附子、干姜，加生地、白芍，数剂而愈。乙未，余在上海，福绥里钱姓小儿，腹痛吐泻，烦躁不安，其师俞梦池，是吾友也，来速余诊。切其脉，数而濡，审是暑邪内蕴为患，合三黄解毒汤、橘皮竹茹汤为方。一剂，吐泻即止。其家更延医视之，医以为螺纹已陷，病在不治。俞君讶甚，又速予往。予见病帆已转，告以保无他虑，令再服前药一剂。明日复诊，腹痛烦躁俱平，眠食亦安，复为调理而愈。又同邑费君伯勋客居上海时，其室患腹痛吐泻，来延余诊。脉象迟缓，知是脾虚寒湿相浸，用理中汤加陈皮、蔻仁，数服而愈。又上海久敬斋王君翼亭之室，患干霍乱症，晌皖懊依，肢体麻木，不吐不泻，来延余诊。脉象涩滞，知是秽暑凝结，用苏合香丸意治之，诸症渐平而愈。又丙申仲春，上海泰源庄某患先泻后吐，饮食不进，医以为客邪外感，迭用汤药不效，来延余诊。脉象模糊，令按胸脘，着手即痛，知是积滞阻中，并寒热二气不和所致。用枳术丸，姜连饮意合治之，服至两时许，即欲饮食。接服二剂，诸症悉平丽愈，此数症者，或益阴，或回阳，或清里，或温中，或解秽，或导滞，俱应手效，可知霍乱症，未可以一法绳矣。然而世之乐善君子，往往不惜重赀，配一丹方，以治千变万化之病，其心诚善，其法则未善也。余尝默体是意，以为至不一之症，而欲以一法治之。治已病，不如治未病，治重病，不如治轻病，因拟就一方，用扁豆四钱，焦曲三钱，陈皮二钱，枳壳、郁金各一钱五分，块滑石五钱，生草一钱。以方中重用扁豆、神曲，故称之曰扁鹊神方。戊子年，吾里霍乱极重，以是方传与亲友，凡有将吐将泻，或吐泻初起昔，及早服之，颇效。十月初，至城南前横镇，有谈行村姓谈名蒙显者，一家止夫妇子三人，早起，同时吐泻，其邻人代觅痧药。与余遇诸途，询知其故，以是药三服与之。傍晚，其夫愈，妻与子病如故。余又以是药两服与之，夜半均愈。乙未六月，余在上海，其时霍乱颇盛，苏友俞梦池索是方，寄归其乡，据云；是药甚效，盖扁豆、甘草、滑石，理脾胃而消暑湿，神由、陈皮、枳壳、郁金，消积滞而利气机，上下既通，清浊自分，则中宫之撩乱可定。药性平和，当与六和等汤，并行不悖，较诸时传丹方，实为稳便。丹方药味，峻烈而偏，用之得当，顷生人，用之不当，亦顷刻杀人。不如此方，有利无弊，且品味寻常，价值亦廉，无论穷乡辟壤，不难顶置以备不虞。倘有欲吐欲泻者，即与一服煎饮，重者可轻，轻者即愈。若服之太迟，则不效矣。所谓救患于已然者难为力，防患于未然者易为功也。至于病之险且危者，又非此药所能疗，须连请高明治之。慎弗因循而自误。
Impediment in urination is categorized into cold, heat, phlegm, dampness, qi stagnation, blood stasis, and deficiency syndromes. Only strangury (Lin syndrome) is mostly due to heat, with cold being extremely rare, because excessive heat generates dampness, leading to turbid urine and forming strangury. In the winter of Gengyin year, I arrived in Jinan. A patient surnamed Xu invited me for consultation. He stated: "Abdominal distension and fullness, astringent and obstructed urination, dripping only drop by drop day and night, urine red and turbid. The illness has lasted five years, and multiple treatments have failed. This summer it suddenly worsened, and became even more severe in winter. Pain in the penis after urination, rebellious Qi from the lower Jiao rising upward, unbearable panting and urgency." I palpated his pulse; all positions were soggy and rapid, except the left Guan and Chi positions which were large and rapid, and forceful upon deep pressure. I knew that although Qi and Blood were deficient due to the long duration of the illness, Damp-Heat in the Bladder was still abundant. Thus, I used Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify Qi; Rehmanniae Radix (Dihuang) and Phellodendri Cortex (Huangbai) to nourish Yin; prepared Rheum Palmatum Rhizoma (Zhijun) and Glycyrrhizae Radix et Rhizoma (Gancao) to clear Heat; Talcum (Huashi) and Akebiae Caulis (Mutong) to promote urination and drain Dampness; Bombyx Batryticatus (Jiangcan) to resolve turbidity; Citri Reticulatae Pericarpium (Qingpi) to move Qi; Achyranthis Bidentatae Radix (Niuxi) as a guiding herb downward; and Puerariae Lobatae Radix (Gegen) to raise Yang. Addressing both root and branch, modifying prescriptions according to symptoms, he recovered after dozens of doses. In the summer of Renchen year, I resided in the capital. A patient surnamed Liu suffered from turbid discharge (Zhuo syndrome), dripping continuously day and night, with distending pain in the tendons of the anterior genitalia extending posteriorly to the anus, lasting over ten days. I diagnosed his pulse as slippery and rapid, knowing that Turbid Pathogen was flourishing. I administered a potent purgative to cleanse filth, expelling numerous amounts of purple-black pus and blood. He recovered in half a month. This shows that for strangury and turbid discharge, if purging methods are used at the onset, the disease is easy to treat, as seen in the latter case. However, if treatment is not appropriate, pathogenic factors linger and transform, inevitably leading to chronic non-healing, as seen in the former case. Someone asked me about the treatment method for the former case. I said: This is a compound formula containing Yang and Yin herbs, warming and clearing herbs, tonifying and purging herbs, descending and ascending herbs. Its opening and closing mechanisms are profoundly subtle. Referencing ancient formulas, it likely derives from Li Dongyuan's Qingzao Tang (Clear Dryness Decoction). Li Dongyuan formulated this decoction to treat constitutional weakness complicated by Summerheat, and all kinds of Damp-Heat syndromes, not specifically for strangury. However, when strangury lasts for years, Zheng Qi (Upright Qi) is already deficient. In summer, the illness aggravates, Summerheat becomes prevalent, urine is turbid with penile pain, and Damp-Heat is particularly heavy. Comparing with Qingzao Tang, the treatment principle fits well. I adopted its intent and used it, resulting in immediate efficacy. After recovery, one must abstain from alcohol and avoid overexertion; otherwise, recurrence due to diet or fatigue is easy to happen. Be cautious.
Spermatorrhea: Yin and Yang Deficiency Syndromes
Kidney Yin deficiency leads to failure of essence to be stored; Liver Yang hyperactivity leads to easy leakage of Qi. Therefore, spermatorrhea is mostly related to Kidney and Liver, but there are also cases where the insufficiency lies in Heart, Lung, Spleen, and Stomach, so one cannot adhere to a single theory. In the winter of Gengyin year, I went to Jinan. A patient surnamed Huang, over fifty years old, had an insecure Jing Guan (Essence Gate), experiencing nocturnal emission first followed by slipperiness. The illness lasted one year, with mental fatigue, weak Qi, and severe physical debility. Frequent use of Liuwei Wan (Six-Ingredient Pill with Rehmannia) was ineffective. He sought my consultation. His pulse was fine and rapid at both Chi positions, and empty and large at Cun and Guan positions. I knew this was sinking of Yang Qi failing to secure essence. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ophiopogonis Radix (Maidong) and Schisandrae Fructus (Wuweizi) to secure and cure him. In Yiwu year, I resided in Shanghai. Shen from Ningbo, in his twenties, was thin with ruddy complexion, suffering from coughing and hemoptysis, and nocturnal emission at dawn. The illness lasted two years without response to medicine. He occasionally consulted me. I diagnosed his six pulses as slippery and rapid, especially strong at the left Chi position, indicating Yin deficiency with Fire. I used Liuwei Wan removing Cornus Officinalis Fructus (Shanzhuyu), adding Scrophulariae Radix (Yuanshen), Phellodendri Cortex (Huangbai), and Alismatis Rhizoma (Cheqian). After ten doses, Fire subsided. After another ten doses, Yin recovered. Advancing with the previous method, adding Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi), he recovered through conditioning. These two cases: the former was Spleen Yang deficiency, the latter Liver Yin deficiency, both are deficiency syndromes. However, Yin and Yang are as different as heaven and earth. If one should tonify and ascend but instead nourishes Yin, Yuan Qi (Original Qi) will sink further; if one should nourish and clear but instead tonifies and astringes, Ministerial Fire will become stronger. Failing to distinguish deficiency and excess, and treating erroneously, the illness will surely worsen. Moreover, stagnation and accumulated heat, as well as all phlegm-fire diseases, often cause emission without dreams, which cannot be effective with pills like Ju Jing Gu Jing Wan (Accumulate Essence and Secure Jing Pills). Ultimately, it relies on the clinician's ability to distinguish deficiency and excess and examine Yin and Yang.
Stroke: Yin and Yang Deficiency and Excess Syndromes
Stroke includes Pian Ku (hemiplegia), Feng Fei (flaccid paralysis of four limbs), Feng Yi (coma), and Feng Bi (numbness and pain). Treatment principles take Qi and Blood as the root, and external pathogens as the branch. In the summer of Yiwu year, Mr. Liu Ziqing traveled from Zhenjiang to Shanghai. Exhausted midway, sweating and exposed to wind, he suddenly suffered Yin stroke. His right arm and leg were weak and unable to hold objects; his tongue was short and stiff, causing speech impediment. Previous doctors used clearing and dispersing medicines without success. Mayor Yang Shengchen invited me to consult. Palpating his pulse, the right side was slow and powerless. I knew this was Qi deficiency in a obese person with insecure Wei Qi (Defensive Qi). I used Duohuo Tang (Angelica Pubescens Decoction), Qianjin Fuzi San (Thousand Gold Aconite Powder), and Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) etc., modifying them, and he recovered after regulation. In the spring of Dingyou year, I was a guest in Tianjin. Wang Jianyu, Magistrate of Wuqiao, suffered from lateral stroke. His right face was swollen, mouth deviated, speech impaired, hands unable to grasp, legs unable to walk, knees and shins felt cold to the bone, food tasted bland, sleep was restless, and irritability was severe. Palpating his pulse, the left was strong and the right weak. Observing his tongue coating, the right was thick and the left thin. I understood this was caused by internal injury from fatigue and labor, combined with external contraction of Wind-Cold. I used Huangqi Fuzi Jianzhong Tang, Fangfeng San (Saposhnikovia Powder), Sangju Jian (Mulberry Leaf and Chrysanthemum Decoction), modifying them. He recovered in over twenty days. These are all Yang deficiency cases cured by Yang herbs. However, there are also Yin deficiency cases cured by Yin herbs. In the spring of Gengyin year, I went to Tianjin. Liu Jiamin, Inspector, suffered from stroke for two days. He could not eat or speak, was comatose with coarse breathing, eyes rolling up, right hand and foot could still move, but left ones were paralyzed. Palpating his pulse, it was slippery, large, and rapid. I knew this was Yin deficiency with Yang hyperactivity, where Wood-Fire carried Phlegm-Fire, mutually fanning each other. Treatment used herbs to clear Fire, resolve Phlegm, calm Liver, and extinguish Wind. Next day, consciousness cleared, and he could sit up. Continuing the previous prescription, assisted by Yin-nourishing and Qi-tonifying methods, after over a month, his diet returned to normal, he could gradually walk, and full recovery was expected. Later, I had business elsewhere, far away. His family hired another doctor who exclusively used warm and dry herbs. Two months passed, Yin Qi was exhausted, frequent urination occurred, worse at night. At this time, emergency rescue for reversal was needed. Referencing ancient formulas, Liuwei Wan with Schisandrae Fructus (Wuweizi) should be used. But other doctors feared using Rehmanniae Radix (Dihuang) and did not dare administer it. The illness eventually proved fatal. Alas, life and death have fixed numbers; one must know drug indications and contraindications. Dihuang (Rehmannia) can be used raw, baked dry, or processed cooked. Benjing states it has effects of dispersing blood, cooling blood, and tonifying blood, hence saying long-term use lightens the body and prevents aging, respected as a top-grade drug. Secular people do not investigate, thinking raw Dihuang causes loose stools and cooked Dihuang clogs the chest, regarding it like arsenic, which is absurd. Raw Dihuang causing loose stools is due to weak Stomach Qi and deficiency; cooked Dihuang clogging the chest is due to much Phlegm and Qi obstruction. These result from not understanding deficiency and excess. Ancient formula Daochi San uses raw Dihuang with Mutong to clear Heart Fire; Qiongyu Gao, Guben Wan, Jiling Gao use dried Dihuang with Ginseng and Er Dong to treat Blood Lao (consumption) with wheezing, coughing, and hemoptysis; Liuwei Wan, Bawei Wan, Siwu Tang all use cooked Dihuang as the sovereign herb. Cooked Dihuang fills bones, grows muscles, generates essence and blood, tonifies internal injuries of Five Zang organs, and treats post-illness soreness in calves and thighs, desire to rise while sitting, and blurred vision. Its function is not slight. Yet later generations stuck to Zhang Shiwang's view that Dihuang is Yin-soft like a conformist, seemingly correct but actually wrong, seemingly beneficial but actually harmful. Even with Yin deficiency and Fire hyperactivity, Five Lao Seven Injuries, they dared not use it. Did they know Shiwang's words meant avoiding slippery raw Dihuang and cloying cooked Dihuang, urging people to distinguish and use them properly, not to discard Dihuang entirely? Wang Haogu said: Raw Dihuang treats Heart Heat and benefits Kidney Water, suitable for洪实 (surging and solid) pulses. For empty pulses, cooked Dihuang is suitable. Clarifying this meaning, Dihuang brings benefit everywhere.
Wei Syndrome due to Damp-Heat
Wei syndrome originates from Lung Heat transmitting to the Five Zang organs. Heat steaming causes Dampness to stagnate, making Qi mechanism unfavorable. It differs from Wind diseases and external contractions which change rapidly. In Yiwu year, I resided in Shanghai. Mrs. Liu Runfu fell ill in summer and autumn, lingering for months. Bedridden, unable to rise or sit, limbs weak and unable to lift. She sought my consultation. Palpating her pulse, it was large and slippery. I knew this was Summer-Damp-Heat accumulating and not resolving, injuring Qi aspect, leading to Wei syndrome. It is no different from plants in summer heat, steamed and scorched, with branches and leaves wilting. Without cool night air to nourish, vital energy cannot arise vigorously. Thus, I used the method of Qingzao Tang, modifying it. After over a month, symptoms completely resolved. In Dingyou year, I was in Tianjin. Early summer, Observer Pan Lige came urgently for his grandson Jin Hua, who had been ill for months. Symptoms included hot palms and soles, continuous night sweats, chest and hypochondriac distension, convulsions and pain, soreness in legs unable to bear weight, flaccidity like paralysis. Palpating his pulse, Cun and Guan were empty and slow, Chi was slippery and solid. I knew this was a false image of Upper Excess and Lower Deficiency. One should abandon symptoms and follow the pulse, treating as Upper Deficiency and Lower Excess. I used Buzhong Yiqi Tang and Qinlian Wuling Tang, modifying them. He recovered in over twenty days. Discussing the treatment of these two cases, it reflects the ancients' idea of "Draining South and Tonifying North". However, sometimes draining is used as tonifying, sometimes tonifying as draining, or both are needed. Intent varies. Moreover, accompanying food stagnation and blood stasis are common in Wei syndrome. I once assisted with digestion-promoting and blood-invigorating methods to achieve efficacy. Treating according to symptoms, how can one method suffice?
Sha Ma (Measles/Scarlet Fever) Deficiency and Excess Syndromes
Sha Ma pathogens steam from Yangming Fu to Hand Taiyin Meridian, and are constrained by external Cold. Thus, initial symptoms include cough and fever. Using acrid-pingued herbs for exterior and nourishing-clearing herbs for interior is the general principle. However, syndromes have deficiency and excess distinctions, and treatment has root and branch differences. In spring of Wuzi year, relative Jiang Zi was critically ill for twenty days. Fever without sweat, measles-like rash all over body, occasional hiccups, incessant diarrhea, gray-black tongue coating, thick, greasy and dry, pulse empty and minute, almost imperceptible upon pressure, coma, weak Qi, unresponsive to calls. Condition critical. I considered this case: Zheng Qi is extremely deficient, on the verge of collapse. Even with external pathogens, treat slowly. Use Korean Ginseng (Gaolishen) 5 qian decocted in water to drink first. Formula: Shiquan Dabu Tang removing Alisma Rhizoma (Fuling), adding Tangerine Peel (Chenpi) and roasted Kudzu Root (Weigen). Administered in large doses. After two doses, spirit slightly revived, able to drink thin porridge, vomiting and diarrhea stopped. Only fever remained unclear, indicating external pathogens could not disperse naturally. Still using previous formula, added Perilla Leaf (Zisu). Some said since taking major tonics, dispersing herbs should not be used. Removing Zisu, he took it, but fever remained. I said: If only deficiency exists, tonification brings peace, dispersion is indeed inappropriate. But if middle deficiency coexists with external pathogens, tonification and dispersion are both necessary. People today do not understand this. When tonification is needed, they don't tonify; when dispersion is needed, they don't disperse. Hence many difficult cases. Do they not know Li Dongyuan treated Yang deficiency with external contraction using Buzhong Tang plus exterior herbs, and Danxi treated Yin deficiency with external contraction using Xionggui Tang plus exterior herbs? Combining tonification within dispersion is most subtle. I added four herbs including Zisu, decocted separately and mixed. After one dose, fever halved; after two doses, fever cleared. Removed Zisu, continued major tonics. After dozens of doses, he recovered. Post-recovery, head, face, nails, and whole body shed skin like molting. The gray-black tongue coating also peeled off largely. In spring of Xinmao year, I was in Shandong. Mrs. Zhou Shenzhiyuan suffered from Sha Ma. Previous doctors used clearing/dispersing herbs, which were rejected and vomited. She sought my consultation. Fever, red face, chest stuffiness, diarrhea, crimson tongue with yellow coating, slippery and rapid pulse. Pressing chest/epigastrium revealed hardness and pain. I knew Warm Pathogen was trying to emerge, but food stagnation blocked the middle. Previous herbs could only disperse pathogens, not guide stagnation out. Hence rejection and vomiting. I kept previous doctor's formula, adding one or two digestion-promoting herbs. After one dose, vomiting/diarrhea stopped, chest relaxed. After two doses, fever cleared, able to drink porridge. Later used nourishing/clearing and regulating herbs. Shedding skin all over, he recovered. These two cases: former resulted in deficiency from illness, latter resulted in illness from stagnation. Treat according to timing and symptoms, weigh causes, and efficacy follows. Why do secular people not investigate? Knowing Qi is deficient but not tonifying, knowing chest has stagnation but not unblocking, why?
Huo Luan ( cholera-like syndrome) Yin/Yang, Cold/Heat, Deficiency/Excess Syndromes
Huo Luan syndrome involves contracting Cold pathogens, Summerheat pathogens, or food stagnation. Pathogenesis varies in depth and location, and Yin/Yang, Deficiency/Excess. Onset is rapid, leaving no time for deliberation. Symptoms may include vomiting without diarrhea, diarrhea without vomiting, simultaneous vomiting and diarrhea, or inability to vomit/diarrhea despite urge. Treatment must not solely use cold/cool herbs, nor exclusively warm/tonic herbs. Nourishing and digesting methods are also sometimes necessary. Rely on treating symptoms as they arise. Adhering rigidly to fixed methods kills easily. Recently, Huo Luan prevailed, causing many deaths, due to rigid adherence. In Wuzi year, I taught at home. Student Mei Quansheng's father contracted Huo Luan at midnight. Treated with Laifu Dan etc., vomiting/diarrhea continued, condition critical. At dawn, sought my consultation. Pulse fine and rapid beyond measure, red face, crimson tongue, thin yellow coating, intermittent abdominal pain. Known as Yin deficiency with Fire. Used Fumai Tang, replacing Hemp Seed (Maren) with Jujube Seed (Zaoren), removing Cinnamon Twig (Guizhi) and Ginger (Shengjiang), adding Coptis Rhizome (Chuanlian) and White Peony Root (Baishao). Vomiting/diarrhea stopped immediately, gradually accepted porridge. Continued modifications, slept and ate peacefully, recovered. Also, Yu Changsheng's wife in Xiaohéyan, pregnant three months, contracted Huo Luan. Pulse invisible, body cold, shoulders warm. Yin and Yang both perishing. Urgent need to restore Yang. Heavy use of Aconite Root (Fuzi), Dried Ginger (Ganjiang), Korean Ginseng (Gaolishen), plus Tangerine Peel (Chenpi) and Roasted Licorice (Zhigancao). One dose, body warmed, feet still cold. Two doses, feet warm, accepted porridge. Yang now predominant, must protect Yin. Remove Fuzi/Ganjiang, add Rehmanniae Radix (Dihuang) and Baishao. Several doses, recovered. In Yiwu year, Shanghai. Child of Qian family in Fusui Li, abdominal pain, vomiting/diarrhea, restlessness. Teacher Yu Mengchi, my friend, summoned me. Pulse rapid and soggy. Summerheat internally trapped. Combined Sanhuang Jiedu Tang and Chupi Zhuru Tang. One dose, vomiting/diarrhea stopped. Family hired another doctor who saw sunken nail ridges, deemed incurable. Yu was surprised, summoned me again. I saw condition improved, assured no danger, advised one more dose. Next day, pain/restlessness gone, sleep/eat well, recovered with conditioning. Also, Fe Boxun's wife in Shanghai, abdominal pain/vomiting/diarrhea. Pulse slow and delayed. Spleen deficiency with Cold-Damp infiltration. Used Lizhong Tang plus Chenpi and Cardamom (Kouren). Several doses, recovered. Also, Wang Yiting's wife in Jiu Jing Zhai, Gan Huo Luan (dry cholera). Midday distress, limb numbness, no vomiting/diarrhea. Pulse choppy/stagnant. Filthy Summerheat congealed. Used Suhexiang Wan strategy. Symptoms gradually resolved. In mid-spring of Bing Shen year, Taiyuan Zhuang patient, diarrhea then vomiting, no appetite. Doctors thought external pathogen, used decoctions ineffectively. Summons me. Pulse vague. Pressing epigastrium painful. Food stagnation blocking middle, Cold/Heat disharmony. Used Zhizhu Wan and Jianglian Yin strategies. After two hours, desired food. Two more doses, all symptoms resolved. These cases: tonifying Yin, restoring Yang, clearing interior, warming middle, resolving filth, guiding stagnation. All effective. Huo Luan cannot be treated by one method. Yet benevolent gentlemen spend heavily on a single pill formula for myriad changes. Their heart is good, method flawed. I pondered: treating diverse illnesses with one method. Treating existing illness is inferior to preventing it; treating severe illness is inferior to treating mild illness. Thus I formulated a prescription: Lablab Bean (Bian Dou) 4 qian, Scorched Malt (Jiaoqu) 3 qian, Tangerine Peel (Chenpi) 2 qian, Aurantium (Zhiqiao) and Curcuma Aromatica Rhizome (Yujin) 1.5 qian each, Block Talcum (Kuai Huashi) 5 qian, Raw Licorice (Shengcao) 1 qian. Named Bian Que Shen Fang (Divine Formula of Bian Que) due to heavy Bian Dou and Shenqu. In Wuzi year, local Huo Luan was severe. Distributed this formula to relatives/friends. For impending or early vomiting/diarrhea, early administration was effective. Early October, Qianheng Town. Tan Mengxian's family of three (husband, wife, child) vomited/diarrheated simultaneously. Neighbor sought Sha medicine. Met me, explained situation. Gave three doses. Evening, husband recovered, wife/child same. Gave two more doses. Midnight, all recovered. June Yiwu, Shanghai. Huo Luan prevalent. Friend Yu Mengchi requested formula for hometown. Reported very effective. Bian Dou, Gancao, Huashi regulate Spleen/Stomach and dissipate Summer-Damp; Shenqu, Chenpi, Zhiqiao, Yujin resolve stagnation and promote Qi mechanism. Upper/lower通畅, Clear/Turbid separate, Middle Jiao chaos settles. Mild nature, compatible with Liuhe Tang, superior to popular pills. Pills are harsh/biased; correct use saves instantly, incorrect use kills instantly. This formula has benefit no harm, common ingredients, cheap price, accessible anywhere. For impending vomiting/diarrhea, give one dose. Severe becomes mild, mild heals. Late administration ineffective. Saving from existing disaster is hard; preventing before occurrence is easy. For dangerous/severe cases, this medicine cannot treat; seek skilled physicians. Do not delay and harm yourself.
Malaria: Exterior/Interior, Yin/Yang, Deficiency/Excess Syndromes