商友王定安庵，幼在京，权子母，工于心计而贪诈猬锁，兼嗜面食，年四十后，得脾劳病，遇冬更甚，医药数年矣。余常劝其节食节劳，而以经营生息，刻无暇晷。每食过饱，则痰嗽喘满，终夜不寝。壬子冬，疾增剧，乃俯余治。余进以健脾诸品，痰嗽少止，而狂啖如故，因之时发时愈。病甚则服药，稍痊则不肯，余以其不能调摄，置之不问。年终，风事匆匆，劳扰更甚，一日早起，则面目四肢俱浮肿，而烦满益不堪，余告其同事曰：脾绝矣。尚未立春，虽交木令，尚可到家，立春后则不能矣。盖肝木克脾土，促春必难过也。同事者不为意，延之。继请一同乡医视之，则曰：此水病，下之则愈矣。问用何药？则曰：舟车丸。余力陈不可，而病者误信之，急服三钱，肿未减，而卧不能兴。诊其脉若有若无。同事惟恐其殁于铺，急觅车傅人送还，出京甫数日，殁于松林店。计其时，立春后五日也。吁！人生固有命，而始则不知爱养，继则不信良言，迨疾不可为，又信庸医，以速成其烈属，亦愚之甚至矣。故录之，以为不知调摄者戒。
寒疟误治
茶商某，忘其名，在都中，夏得疟病。医药数进，而午后必寒战经时许。沉绵者数月，渐至体肤削减，饮食少进，出入随人扶掖，又年过五旬，获利不丰，家无子嗣，言必长叹，已不作生活计矣。适秋间，余到其铺，有契友田时甫扶之来求余治。见其面若败灰，气息仅属，诊其脉，则六部皆沉细迟微，右关更不三至。乃曰：此固疟疾，然疟系外感，初发时，解之清之，无不愈者。君病时所服，必草果，常山等劫药，中气本属虚寒，再克伐之，必无痊日。此时满腹虚寒，中气大馁，仍作疟疾治，是速其毙也。时甫曰：尚可治否？乃云：六脉虽虚，毫无坏象，何至不治。因进以附子理中汤，越日而寒战去。再进以补中益气汤加白芍、白蔻、肉桂数种。五日而饮食进，半月后如常矣。
酒肉内伤感寒生痰
裕州刺史李莲舫，幼与余为文字交，以辛亥孝廉由议叙得州牧，在京候选，与余同住襄陵会馆，寝馈共之，每日与各相好宴乐，暮出夜归，风寒外感，且数中煤烟毒最可畏。一日余卧中夜尚来起，其弟小园促之曰：家兄病甚，速请一视。余急披衣视之，浑身颤汗，转侧不安。问之，则胸中烦闷特甚，欲吐不吐，且心头突突动。急提左手诊之，则平平无病状，余曰：病不在此也。易而诊右，脉寸关滑而泉涌。乃曰：此酒肉内薰，风寒外搏，且晚间煤火，渐而生痰。乃以二陈汤加麦芽、山楂、神曲，并芩、连、枳实等立进之，刻许安卧，至巳刻急起如厕，洞下红黄色秽物数次，午后胸平气定，进粥一盂。又欲趋车外出与友人作消寒之会，余急止之曰，朝来颠倒之苦竟忘之耶。一笑而罢。
后腊月莲舫西归，余移与小园同榻，一日天未明，闻小呻吟甚急，起而视之，病症脉象与莲舫无少区别。乃曰：君家昆玉，真是不愧，乃以治莲舫之药治之，所下与莲舫同，其愈之速亦同。晚间其仆乘间言曰，家主兄弟之病，幸老爷一人治之，若再易一医，必别生枝节，支曼不清矣。其言近阅历者，乃首颔之。
饱食冷饮凝结不通
余在京用庖人某，忘其名，拙艺粗才，百无一长，以奔走枵饿之腹，骤得饱餐，啖饮兼数人之量。又常饮凉水，众止之，曰：余惯此，不吃茶也。一日忽患腹痛，少食辄吐，大便闭，汗出如雨，呼号辗转，众以为急症。余曰：此饱食伤胃，兼冷水凝结，大便通，则愈矣，故置不问。晚餐后，匍匐求余，挥涕不止，乃难之曰，疾由自取，余何能为，必欲余治尔病，先取十桶水，置两缸倾倒之，必足三十度，然后可。庖人曰：小人病莫能兴，十桶水何由致！余曰：不能则勿望余治也。不得已，饮恨力疾而起。同人以余为太忍。庖人乃取水如命倾倒之，未至二十度，腹中漉漉鸣，汗津欲滴，急如厕，洞下之，软不能起。同人扶之床，坦然睡去。二刻许稍醒，则腹虚体轻，求饮食矣。余入厨问曰：腹尚痛否；曰不痛矣。尚作呕否；曰不呕矣。乃曰：尔之病，我已治之愈，比汤药针灸何如？取水之苦，可不怪我矣。庖人惭惧叩头。又告之曰，后须少食，不然将复痛，庖人敬诺．
同寓者请其故，余曰：余命取水倾倒，则俯仰屈伸，脾胃自开，焉有不愈者。众乃服。或曰，何不用药，余曰，用平胃散合承气汤，未尝不可，但药可通其肠胃，不如令其运动，皮骨具开，较药更速也。
过劳中暑
伶人某，忘其名，四喜部名旦也，六月初，演泗州城剧，众称善。有某官爱其艺，又出钱命演卖武一折，身体束缚，刀矛剑戟之类，旋舞越二时许，卸妆入后台，则大吐不已，腹中绞痛，急载归家，吐止而昏不知人，推之不醒。其师怒，遣人寻某官，某官知余名，又转同乡请余诊视，乃偕之往，则剩粉残脂，犹晕面颊，汗出如油，气息促迫，呼之不应。提其腕，则六脉浮濡，按之反不见。余曰：此中署阳邪也，命守者以热鞋熨其脐，刻许，稍醒。逐以大剂香薷饮进之，二日而安。后三日，有投小片者，不知其人，问阍人，乃知其伶来谢也，余却而避之。
痘疹气虚过服寒凉
乙卯夏在都，一日将直圆明园，衣冠而出，将登车，忽一老妪跪车下，自言伊孙病痘甚危，闻老爷善医，敢乞一救小孙之命。余恐误公，辞以本不善医，痘疹尤所未习，使之再觅他医，而妪涕零如雨，挥之终不去，叩头几见血，旁多代为请者，无奈，急随之，走不数武，已至其家，盖右邻有乳媪，日在街望，阍人告之也。视之，乃一男，约四五岁，见其痘形平板，色不红润，手足发厥，且时作泻。法在危险，而颗粒分明，大小匀称，且日进粥三二碗。余曰：气虚不能托送，又过服寒凉，以致不起。问几日？曰：十日矣。视所服之方，则芩连之属类多，因示以六味回阳饮（方：附子炮姜甘草当归党参肉桂加胡淑灶心土），其家问几服？曰，须二三服乃可。随言随走，连日公忙，几忘其事。又一日雨后，不能远出，闲到门外，前妪抱儿而至，投能作谢。余方忆其事。戒之曰，痘后之风，当谨避也。妪遂携儿而返。
阴虚血热误用桂附
商友梁某，素有痔，兼好鸦片，发则痛不能起，且有隐疾，未尝告人。一日痔发，不可忍，延一南医治之。梁素弱，面目削瘦，饮食不思，南医以为虚也。用桂附补之，二日而腹膨如鼓，烦闷不安，因而痔益增痛。急延余往视之，脉细数而有力。余曰：阴亏血热，且增烦躁，故痔作。鸦片最燥肺，肺主气，气燥而血亦不润矣。再以桂附火之，无怪其增痛也。
昔人虽谓痔有虚实，而未有不由湿热内蕴者，先清其热，则痛止。遂用槐花散加归芍而进之，夜半痛少止。次日又往，则进以归芍地黄汤，十日而愈。他日告余曰：不惟病愈，痔亦愈。余日：痔何能去？特血润则不痛矣。须薄滋味，谨嗜欲，节劳逸，方可渐望其去。否则，发作无时。目中所见，固少因痔而死者，亦少治之痊愈者。梁首肯。后余以内艰（母丧或长孙祖母之丧）归家。越三年余，梁来信云，本年痔发特甚，惟服君前药少止，然成长命债矣。
肝郁呕血
穆某之副夥，忘其姓名。素有呕血疾。因见穆某病危，铺事纷集，以急躁故，呕血转甚，亦求余冶。余问曾服药否?曰，药不离口者数年矣。而作发无时,见逆事则益甚。为诊其脉，并不甚虚，左关弦滑如涌，且有坚象。余曰，此肝郁也。君初得病时，必因暴怒，此后必胁间时时刺痛，甚则呕，色必紫黯。曰诚然，先生何如见也？乃以左金丸合颠倒木金散（郁金木香）解其郁，继用逍遥散舒其肝，命常服养血平肝之剂，戒其忿怒。一月而后酒肉来谢，余却而问其病，曰：服逍遥散后，已胸胁宽舒，血归乌有，先生命长服之药，不欲服也。余听之。
外感风热
马景波孝廉，与余为文字交，又同出龙兰簃先生门下，故称莫逆。乙卯谋纳粟作宰，都中有女校书才色超群，马昵之。一日余赴同乡之饮，在前门酒市，席未半，景波遣其仆，趋车迎余曰：家主得暴疾，危在顷刻，亟请视之。余颇惊骇，乃投箸登车而去，曲折经数处，见非景波所栖止。因问其车夫，车夫扬鞭掉臂曰：老爷至则自知。到陕西巷则景波依闾已久，捐余曰：校书病甚，惟恐君不来，故托于余以速之，急请入一施汤剂。余乃知为校书病。入其室，数媪环守之。启衾看，则校书篷首赤体，昏不识人。扪其肌，热可烙手，面赤气粗，颠倒烦乱．提腕诊之，六脉浮数，几乎七至。乃曰：此外感风热也，一发可愈。乃开防风通圣散易麻黄以桂枝。景波争曰；硝黄劫药，校书娇姿恐不堪。余曰：君情深如此，宜校书之倾倒，然君解怜香，我岂好碎玉耶，有病则病当之，保无恐。急遣下走货药，煎而进之。属曰：三更后，当大汗，渴，勿多与饮，明早必愈，我去矣。
越日申刻，余公退将入门。景波又遣车迎余曰：校书病益甚，请再视之。余骇曰：既病甚，则药病枘凿（不相合）。可请别人，余不必往也。其仆曰：家主望君如岁，不去，恐小人获戾。不得已，随之至。则景波颦惑曰：病益甚，当奈何？见校书仍拥衾卧，蒙其面。揭之则花妆簇簇，跃然而起。继命媪辈，皆敛衽叩头曰：昨宵服君药，三更如梦醒，浑身出汗，到晓，病若失。服君之奇，感君之义，特设一筵，置酒为乐。恐君不来，故托辞招之耳。余故不喜此辈，拟托公而辞。校书跪留曰：自知垢污之肴，不足染高贤之腹。然献芹之忱，窃难自己。言之泪欲下。景波急进曰：勾栏（妓院）中一杯水，未必即阻两庑特豚（古代祭礼）。何惺惺作态乃尔。余不敢再辞，相与狂饮．肴错纷陈，至夜四更始罢。归检衣袱则罗香囊一对．絮绢方巾二事在焉。知为校书之遗．越数日，转景波而还之。
饮食伤胃
商人曹某，忘其名，豪于饮，而食量亦复兼人。夏月奔走发渴，多食生冷，遂致停滞，头痛发热，腹胀神昏。他医以为感冒，以风药散之，不效。乃迎余视。其右关坚大，右尺弦缓，并无浮象。乃曰，此饮食伤胃也，必见食作呕逆。弦者停饮之象，不去之不快也，此类伤寒中五症之一，视为外感，失之远矣。急以对金饮子（方：桔红厚朴苍术甘草生姜大枣）加大黄、槟榔等破之，二服而腹减热退。五日后来谢曰：余未病时，常有呕逆手颤疾，不知何故？告之曰：此酒积也。试服葛花解酲丸，当必愈。曹即服之至半斤而宿疾全清矣。
湿热内蕴实而误补
庚戌春，余以选拔赴廷试，有同年张君，久雨之后，兼嗜茶饮，六月初患小便不通，数日而手足渐肿，渐至喘咳不能卧。有其同县人商于京，颇知医，告之曰：此阳虚水肿病也。少年酒色过度，精气内虚，非金匮肾气丸不可。张信之，服未一两，肿愈甚，喘亦增，转侧需人，自以为不可救药矣。有同乡荐余往视，六脉俱伏，目睁睁不得合，乃曰：此谓水肿信不谬，而阳则不虚，盖由湿热相搏，水不由小便去，泛于皮肤，故作肿耳．实证而补之，焉有好处！且病即虚，而古人云，急则治其标。先消水泻肿，后补其虚，乃为正路。今以补虚为泻水，非通之，乃塞之也。命市舟车神佑丸（方：二丑大黄甘遂大戟芫花青皮桔红槟榔）服之，四钱而小便泉涌，越两日而肿消喘定，又命服桔半枳术丸（方：桔皮半夏炒枳实白术）半斤，而全愈矣。
过饮致泻误用提补
大同同年姜验熊，入京赴京兆试，与余同寓三忠祠，文酒谈宴甚相得也。秋初阴雨经旬，兼北人不耐潮湿，一日友人招饮，归来渴甚，饮水过当，越日而泻，日经数十次，颇觉困惫。乃自市补中益气汤提补之。次早，则头晕呕逆，腹痛身热，午后高卧不起。余叩其门，乃曰：今日病甚。余日：夏月得泻疾，可去腹中糟粕，何必过计。姜乃以所服之药告。余曰：君何贸贸若此。姜曰：曾忆家君得泻疾，服此甚效，兹则增剧，实所不解。余曰；尊大人必年老气虚，中气不摄，日久滑泻，故以补中益气提之无不效者。君饮水过度，清浊不分，小便不通，水皆从大便而出，急宜疏利，乃反提之，若大便再不通，则腹鼓身肿，成大症矣。遂遣仆买胃苓丸（平胃散合五苓散）二两，令以姜水送之。次日而小便通，又次日而水泻止矣。
肝气凝结而致寒疝
常少张炳堂同乡，甲寅得疝病，肾囊重坠，膀胱时作痛楚，适入值圆明园，出城门路砌以石，长数十里，行者车倾侧，车中人四肢竭力支持，多以为苦。炳翁一往返，疝痛甚，肾囊欲肿。延医视之，仓卒不暇细诘病状。因曰：肾囊肿多是湿热下陷，利水清火痛自除。炳翁于歧黄素愦愦，急服其药，痛增甚，腰胁不可屈伸。乃命余视，诊其脉象沉迟，季肋丸丸，直上直下。乃曰，此寒疝也，病由肝气凝结，胁下如柱，非温血养胁不可，利水清火，不增甚何为。乃为合茴香丸一料送之，服未一两而痛减。适有盛京视学之命，炳翁即束装出关。冬季来函，则曰，药已服完，疝不再发，余犹以温养告之云。
阴虚内热伤脾唾血
[Background Information]
Book Title: Zuihua Chuang Yi An (Medical Cases from the Drunken Flower Window)
Chapter: Main Text (2/9)
Category: Medical Discussion
Shang You Wang Ding'an resided in a monastery. In his youth, he engaged in business in the capital, lending money at interest. He was shrewd and calculating, greedy and deceitful, and had a fondness for wheat-based foods. After the age of forty, he developed Pi Lao disease (a chronic consumptive disease caused by spleen-stomach deficiency and overexertion), which worsened in winter. He had sought medical treatment for several years. I often advised him to moderate his diet and avoid overwork, but he was too busy with his business to find any leisure. Whenever he ate until overly full, he would experience excessive phlegm, coughing, asthma, and chest fullness, keeping him awake all night. In the winter of the Renzi year, his illness intensified, and he begged me to treat him. I administered herbs for strengthening the Spleen, which slightly alleviated his phlegm and cough, but his gluttony remained unchanged; thus, his condition fluctuated between remission and exacerbation. He only took medicine when the illness was severe and refused it when slightly recovered. Considering his inability to regulate his lifestyle, I ceased my inquiries. At the end of the year, due to urgent business matters and increased exertion, one morning upon waking, he presented with edema of the face, eyes, and four limbs, accompanied by unbearable irritability and fullness. I told his colleagues, "The Spleen function is exhausted." Although the Lichun (Start of Spring) solar term had not yet arrived, and the Wood command had technically begun, allowing time for him to return home, after Lichun, this would be impossible. This is because Liver Wood overacts on Spleen Earth; once spring arrives, survival will be difficult. The colleagues did not take this seriously and continued to seek other doctors. Later, a fellow townsman doctor was invited. He stated, "This is Shui Bing (Water Disease/Edema); purgation will cure it." When asked for the prescription, he replied, "Zhou Che Wan." I strongly argued against this, but the patient, misled, hastily took three qian. The swelling did not decrease, but he became bedridden. His pulse was faint and indistinct. Fearing he might die in the shop, his colleagues urgently arranged transport to send him home. Only a few days after leaving the capital, he passed away at Songlin Shop. Calculating the time, it was five days after Lichun. Alas! Human life is indeed governed by destiny, but he failed to cherish his health initially, ignored good advice later, and when the disease became incurable, trusted quacks, hastening his demise. This demonstrates extreme foolishness. Therefore, I record this case as a warning to those who do not know how to regulate their lives.
A tea merchant, whose name I have forgotten, contracted malaria (a disease characterized by alternating chills and fever) in the summer while in the capital. Despite multiple treatments, he experienced chills every afternoon for about an hour. After months of lingering illness, he became emaciated, his appetite diminished, and he required assistance to walk. Being over fifty years old, earning little, having no sons, and sighing frequently, he had given up hope of continuing his business. In autumn, I visited his shop, where my friend Tian Shipu brought him to seek my treatment. His complexion resembled ash, and his breath was weak and barely perceptible. His pulse in all six positions was deep, fine, slow, and faint, with the Right Guan position beating less than three times per breath cycle. I said, "This is indeed malaria, but malaria is an external contraction. In its initial stage, releasing the exterior and clearing heat invariably leads to recovery. The medicines you took during your illness were likely Cao Guo (Tsaoko Fruit) and Chang Shan (Dichroa Root), which are coercive drugs that damage healthy Qi. Your Middle Jiao Qi was originally deficient and cold; further attacking it ensures no recovery. Currently, your abdomen is filled with deficiency-cold, and your Middle Qi is severely depleted. Treating this as malaria now will accelerate your death." Tian Shipu asked, "Is there still hope?" I replied, "Although the six pulses are deficient, there are no signs of collapse; why say it is untreatable?" I prescribed Fuzi Lizhong Tang (Cinnamon Twig and Aconite Decoction to Warm the Middle and Dispel Cold). The next day, the chills ceased. I then prescribed Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) with added Baishao (White Peony Root), Baiko Ren (White Cardamom Seed), and Rougui (Cinnamon Bark). After five days, his appetite improved, and within half a month, he recovered completely.
Internal Injury from Alcohol and Meat, External Contraction of Wind-Cold Generating Phlegm
Li Lianfang, Prefect of Yuzhou, was a literary friend of mine since childhood. He obtained the position of Prefect through recommendation after passing the Xiaolian examination in the Xinhai year and was awaiting appointment in the capital. We lived together in the Xiangling Guild Hall, sharing meals and lodging. Every day, he feasted with friends, going out at dusk and returning at dawn, contracting wind-cold externally, and repeatedly inhaling toxic coal smoke, which is particularly harmful. One night, while I was sleeping, his younger brother Xiaoyuan urged me, saying, "My elder brother is critically ill; please come quickly to see him." I hurriedly dressed and examined him. He was trembling and sweating profusely, restless and unable to turn over. Upon inquiry, he complained of severe chest irritability, a desire to vomit without success, and palpitations. I checked his Left wrist first; the pulse was normal. I said, "The pathology is not here." Switching to the Right wrist, the Cun and Guan positions were slippery and surging like a spring. I diagnosed, "This is internal steaming from alcohol and meat, external combat by wind-cold, compounded by phlegm generation from evening coal fires." I immediately prescribed Erchen Tang (Two-Aged Decoction) with added Maiya (Malt), Shanzha (Hawthorn Fruit), Shenqu (Medicated Leaven), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Zhishi (Immature Bitter Orange). After a short while, he lay quietly. At Si hour (9–11 AM), he suddenly rose to use the toilet, passing red-yellow foul stools several times. By afternoon, his chest felt clear, his breathing stabilized, and he consumed a bowl of porridge. He wished to ride out to join friends for a winter-warming gathering, but I stopped him, asking, "Have you already forgotten the distress of this morning?" He laughed and agreed.
Later, in the twelfth lunar month, Li Lianfang returned west. I moved in with Xiaoyuan. One day before dawn, I heard Xiaoyuan groaning urgently. Upon rising to check, his symptoms and pulse were identical to Li Lianfang's. I said, "Your brothers truly live up to their lineage." I treated him with the same prescription used for Li Lianfang. The stool passed was similar, and the speed of recovery was also the same. That evening, his servant whispered, "Fortunately, Lord [my title], you alone treated the master's brothers. If another doctor had been consulted, complications and confusion would surely have arisen." His words showed experience, and I nodded in agreement.
Excessive Eating and Cold Drinks Causing Congestion and Obstruction
I employed a cook in the capital, whose name I forgot. He was mediocre in skill and talent, lacking any particular strength. Having worked hard on an empty stomach, he suddenly indulged in a large meal, eating and drinking the equivalent of several people. He often drank cold water. Despite others' warnings, he said, "I am accustomed to this; I do not drink tea." One day, he suddenly suffered from abdominal pain, vomiting after eating small amounts, constipation, profuse sweating, and rolling around in agony. Others considered it an acute emergency. I said, "This is injury to the Stomach from overeating, combined with coagulation from cold water. Once the bowels move, he will recover." So I disregarded it. After dinner, he crawled to beg for my help, weeping uncontrollably. I rebuked him, saying, "You brought this upon yourself; what can I do? If you insist I treat you, first fetch ten buckets of water, pour them into two tubs, repeating this motion thirty times, and then I may consider treating you." The cook said, "I am too sick to stand; how can I fetch ten buckets?" I replied, "If you cannot, do not expect my treatment." Reluctantly, he rose despite his resentment. Colleagues thought me too cruel. The cook fetched the water and poured it as ordered. Before reaching twenty repetitions, his abdomen gurgled loudly, sweat dripped from his body, and he rushed to the toilet, passing large amounts of soft stool, becoming too weak to stand. Colleagues helped him to bed, where he slept peacefully. After about two ke (approx. 45 minutes), he woke slightly, feeling light and empty in the abdomen, and requested food. I entered the kitchen and asked, "Does your abdomen still hurt?" He said, "No." "Are you still nauseous?" He said, "No." I said, "Your illness is cured by my treatment. How does this compare to herbal decoctions or acupuncture? You should not blame me for the hardship of fetching water." The cook knelt in shame and fear. I added, "In the future, eat less, or the pain will return." The cook respectfully agreed.
Roommates asked for the reason. I explained, "By ordering him to fetch and pour water, his bending and stretching naturally opened the Spleen and Stomach channels. How could he not recover?" They were convinced. Someone asked, "Why not use medicine?" I replied, "Using Pingwei San combined with Chengqi Tang would not be inappropriate, but medication opens the intestines and stomach, whereas inducing movement opens the skin and bones more rapidly than drugs."
Overexertion and Heatstroke
A certain actor, whose name I forgot, was a famous dan role performer in the Sixxi Troupe. In early June, he performed in the play *Sizhou Cheng*, receiving much praise. An official admired his artistry and paid for him to perform a martial arts segment (*Mai Wu*). Bound tightly, wielding swords and spears, he danced and spun for about two hours. After removing makeup backstage, he vomited incessantly and suffered severe abdominal colic. He was rushed home; vomiting stopped, but he fell into a coma, unresponsive to pushing. His master, angry, sent someone to find the official. The official knew my reputation and asked a fellow townsman to invite me. Accompanying us, we found him with residual powder on his cheeks, sweating like oil, breathing rapidly and shallowly, unresponsive to calls. His six pulses were floating and spongy, vanishing upon pressure. I said, "This is heatstroke caused by Yang pathogenic factors." I instructed the attendants to warm his navel with hot shoes. After a moment, he regained consciousness. I then administered a large dose of Xiangru Yin (Elsholtzia Decoction). He stabilized in two days. Three days later, someone delivered a small gift/note. The gatekeeper informed me it was the actor coming to thank me. I declined and avoided meeting him.
Qi Deficiency in Smallpox and Overuse of Cold/Cooling Medicines
In the summer of the Yimao year in the capital, I was preparing to leave for the Yuanmingyuan Palace for duty. As I was dressing to board my carriage, an old woman knelt before the wheels, claiming her grandson was critically ill with smallpox. Hearing of my medical skills, she begged me to save her grandson. Fearing I would delay my official duties, I declined, stating I was not skilled in medicine, especially smallpox, and suggested she seek another doctor. However, she wept bitterly, refusing to leave, and kowtowed until her head bled. With many bystanders pleading on her behalf, I reluctantly followed. Within a few steps, we reached her home; a wet nurse from the neighboring house had alerted the gatekeeper. The patient was a boy, approximately four or five years old. His pustules were flat, lacking rosy color, with cold extremities and occasional diarrhea. According to standard protocols, this was dangerous, yet the lesions were distinct and evenly sized, and he was consuming two to three bowls of porridge daily. I diagnosed, "Qi deficiency fails to push out the toxin, exacerbated by overuse of cold/cooling medicines, leading to this critical state." Asking how many days, she replied, "Ten days." Reviewing previous prescriptions, they consisted mostly of Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome). I prescribed Liuwei Huiyang Yin (Six-Ingredient Decoction to Return Yang), containing Fuzi (Prepared Aconite Root), Paojiang (Prepared Ginger), Gancao (Licorice Root), Danggui (Angelica Sinensis), Dangshen (Codonopsis Root), Rongui (Cinnamon Bark), plus Huoshuzaoxintu (Charred Hearth Soil). The family asked for the dosage. I said, "Two or three doses are necessary." Speaking while walking, I left. Busy with official duties for consecutive days, I nearly forgot the matter. One rainy day, unable to travel far, I walked outside and saw the old woman approaching with the child, presenting a token of gratitude. I recalled the case and warned her, "After smallpox, one must strictly avoid wind." She took the child and left.
Yin Deficiency and Blood Heat Mismanaged with Cinnamon and Aconite
Shang You Liang Mou suffered from hemorrhoids and had an opium addiction. During flare-ups, the pain was incapacitating. He also had a hidden ailment he never disclosed. One day, his hemorrhoids flared unbearably, and he consulted a Southern physician. Liang was frail, emaciated, and had lost his appetite. The Southern physician diagnosed deficiency and prescribed Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) to tonify. After two days, his abdomen distended like a drum, he felt irritable and uncomfortable, and the hemorrhoid pain intensified. Urgently, I was called to examine him. His pulse was fine, rapid, and forceful. I said, "Yin deficiency with blood heat, compounded by irritability, causes the hemorrhoids. Opium dries the Lung; the Lung governs Qi. Dry Qi leads to dry Blood. Using Fire-natured herbs like Cinnamon and Aconite explains the increased pain."
Although ancients classified hemorrhoids as excess or deficiency, none arise without internal accumulation of damp-heat. Clearing the heat first stops the pain. I prescribed Huaihua San (Sophora Flower Powder) with added Danggui (Angelica Sinensis) and Baishao (White Peony Root). The pain subsided slightly by midnight. The next day, I prescribed Guishao Dihuang Tang (Rehmannia Decoction with Angelica and White Peony). He recovered in ten days. Another day, he told me, "Not only did the main illness heal, but the hemorrhoids disappeared too." I asked, "How can hemorrhoids disappear?" He replied, "Only because the blood is moistened, so there is no pain." I advised, "Maintain a bland diet, guard against desires, and moderate work and rest. Only then can you hope for gradual resolution. Otherwise, attacks will occur unpredictably. In my experience, few die from hemorrhoids, and few are fully cured." Liang nodded. Later, I returned home due to a maternal mourning period. Over three years later, Liang wrote, "This year, my hemorrhoids flared severely. Only your previous prescription provided slight relief, but it has become a lifelong burden."
Liver Qi Stagnation Leading to Hematemesis
A deputy clerk of Mu Mou, whose name I forgot, suffered from chronic hematemesis. Seeing Mu Mou critically ill and facing accumulated shop responsibilities, his anxiety caused the hematemesis to worsen. He sought my treatment. I asked if he had taken medicine. He replied, "Medicine has been in constant use for years." The episodes occurred unpredictably, worsening upon encountering adverse events. His pulse was not significantly deficient; the Left Guan position was wiry, slippery, and surging, with a firm quality. I said, "This is Liver Qi stagnation. Initially, your illness must have been triggered by sudden anger. Since then, you must have experienced frequent stabbing pain in the hypochondrium, sometimes vomiting purple-dark blood." He confirmed, "Indeed, Sir, how did you know?" I prescribed Zuojin Wan (Left Metal Pill) combined with Diandao Mujin San (Turning Over Turmeric and Costus Powder) to resolve stagnation, followed by Xiaoyao San (Free and Easy Wanderer Powder) to soothe the Liver, advising regular intake of blood-nourishing and Liver-calming agents, and warning against anger. One month later, he brought wine and meat to thank me. I declined the gifts and asked about his condition. He said, "After taking Xiaoyao San, my chest and hypochondrium felt relaxed, and the blood issue vanished. I no longer wish to take the long-term maintenance medicine you prescribed." I accepted his decision.
External Contraction of Wind-Heat
Ma Jingbo, a Xiaolian degree holder, was a close literary friend of mine, both studying under Master Long Lanyi. In the Yimao year, he sought to purchase an official post. In the capital, there was a courtesan of exceptional talent and beauty, whom Ma favored. One day, while attending a banquet hosted by a fellow townsman at Qianmen Wine Market, halfway through the meal, Ma's servant arrived by carriage to summon me urgently, saying, "My master has fallen suddenly ill; his life hangs in the balance. Please come immediately." I was startled, dropped my chopsticks, and boarded the carriage. After winding through several streets, I realized we were not heading to Ma's residence. I questioned the driver, who whipped the horse and said, "You will know when we arrive." At Shaanxi Alley, Ma was waiting anxiously by the door. He whispered, "The courtesan is critically ill. Fearing you would not come, I deceived you to hurry you. Please enter and prescribe medicine." I realized the patient was the courtesan. Entering her room, several old women guarded her. Lifting the quilt, she was disheveled and naked, unconscious. Her skin burned to the touch, her face was red, breathing coarse, and she was agitated and confused. Her six pulses were floating and rapid, almost seven beats per breath cycle. I diagnosed, "This is external contraction of wind-heat. It can be cured with one release." I prescribed Fangfeng Tongsheng San (Wind-Protecting Universal Rescue Powder), replacing Mahuang (Ephedra) with Guizhi (Cinnamon Twig). Ma objected, "Xiaoshi (Mirabilite) and Dahuang (Rhubarb) are harsh purgatives; the courtesan's delicate constitution may not withstand them." I replied, "Your deep affection explains her admiration for you. But just as you understand how to cherish fragrance, do I wish to break jade? The disease bears the brunt of the medicine; have no fear." I urgently dispatched someone to buy the herbs, decocted them, and administered them. I instructed, "After the third watch, there will be profuse sweating. If thirsty, do not drink excessively. He/she will recover by tomorrow morning. I am leaving."
The next day at Shen hour (3–5 PM), as I finished official duties and approached my door, Ma sent another carriage summoning me, saying, "The courtesan's condition has worsened; please examine her again." I was alarmed, saying, "If the condition worsens, the medicine does not match the disease. Please ask someone else; I need not go." The servant pleaded, "My master waits for you like rain after a drought. If you do not come, I fear punishment." Reluctantly, I went. Ma frowned and asked, "The condition worsens; what shall we do?" The courtesan was still lying under covers, face covered. Upon lifting it, she was heavily made-up and sprang up joyfully. She then ordered the old women to bow deeply, saying, "Last night, after taking your medicine, I woke from a dream at the third watch, sweating all over. By dawn, the illness had vanished. We admire your miraculous skill and feel grateful for your righteousness. We prepared a banquet to celebrate. Fearing you would not come, we used this pretext to invite you." I disliked such people and intended to decline citing official business. The courtesan knelt and pleaded, "I know my humble food is unworthy of a noble guest. Yet, my sincere offering is hard to withhold." Tears welled in her eyes. Ma quickly interjected, "A cup of water in a brothel hardly obstructs a grand sacrifice. Why pretend so?" I could not refuse further and drank heartily with them amidst a feast, lasting until the fourth watch of the night. Returning home, I checked my bag and found a pair of silk sachets and two cotton handkerchiefs, gifts from the courtesan. Several days later, I returned them via Ma.
Dietary Injury to the Stomach
Merchant Cao Mou, whose name I forgot, loved drinking and had a large appetite. In summer, running around caused thirst, leading to excessive consumption of raw and cold foods. This resulted in food stagnation, headache, fever, abdominal distension, and mental confusion. Other physicians diagnosed it as a common cold and used diaphoretic herbs, with no effect. I was summoned. His Right Guan pulse was firm and large, and the Right Chi pulse was wiry and slow, with no floating quality. I said, "This is dietary injury to the Stomach. There must be nausea/vomiting upon seeing food. Wiry indicates fluid retention; it must be removed for relief. This is one of the five syndromes in Shanghan (Cold Damage). Mistaking it for an external contraction is a significant error." I urgently prescribed Duijin Yinzi (Golden Cup Infusion) with added Dahuang (Rhubarb) and Binglang (Areca Seed) to break the stagnation. After two doses, abdominal distension decreased and fever subsided. Five days later, he came to thank me, asking, "Before falling ill, I often suffered from nausea and hand tremors. What was the cause?" I explained, "This is alcohol accumulation. Try Ge Hua Jie Ying Wan (Kadsura Flower Decoction to Resolve Intoxication)." Cao took half a jin (approx. 500g) of the pills, and his chronic ailments cleared completely.
Internal Accumulation of Damp-Heat, Excess Syndrome Mismanaged with Tonification
In the spring of the Gengxu year, I traveled to the capital for the imperial examination. My fellow examinee, Jun Zhang, after prolonged rain and a habit of drinking tea, developed urinary obstruction in early June. Within days, his hands and feet swelled, progressing to wheezing, coughing, and inability to lie flat. A fellow townsman merchant in the capital, knowledgeable in medicine, advised, "This is Yang-deficiency edema. Due to excessive alcohol and sexual activity in youth, essence and Qi are internally deficient. Only Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) will suffice." Zhang believed him. After taking less than one liang (approx. 30g), the swelling worsened, and wheezing increased. He needed assistance to turn over and believed he was incurable. A fellow townsman recommended me. His six pulses were hidden/deep, and his eyes remained open, unable to close. I said, "The diagnosis of edema is correct, but Yang is not deficient. This is due to damp-heat clashing; water fails to exit via urine and floods the skin, causing swelling. Tonifying an excess syndrome yields no benefit. Even if the disease involves deficiency, the ancients said, 'In emergencies, treat the branch first.' First eliminate water and reduce swelling, then tonify deficiency. This is the correct path. Now, using tonification to treat water retention is not unblocking, but blocking." I ordered the purchase of Zhouche Shenyao Wan (Boat-Chariot Divine Protection Pills), containing Erchou (Bruchus Seeds), Dahuang (Rhubarb), Gansui (Kansui Root), Daji (Euphorbia Root), Yuanhua (Genkwa Flower), Qingpi (Aged Tangerine Peel), Juhong (Ponkan Peel), and Binglang (Areca Seed). Taking four qian, his urination surged like a spring. After two days, swelling subsided, and wheezing stabilized. I then prescribed Juban Zhiju Wan (Citrus and Pinellia Aurantium-Atractylodes Pills) for half a jin, leading to complete recovery.
Diarrhea Caused by Overdrinking, Mismanaged with Ascending Tonification
Jiang Yanxiong, a fellow examinee from Datong, came to the capital for the Beijing Metropolitan Examination. We shared lodgings at the Santemple Shrine, enjoying literary and wine gatherings. In early autumn, after ten days of continuous rain, and being unsuited to the northern dampness, a friend invited him to drink. Returning extremely thirsty, he drank excessively. The next day, he developed diarrhea, occurring dozens of times a day, causing significant fatigue. He purchased Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) to ascend and tonify. The next morning, he suffered dizziness, nausea, abdominal pain, and fever, remaining in bed all afternoon. I knocked on his door, and he said, "My condition has worsened today." I said, "Diarrhea in summer helps expel waste from the abdomen; why worry excessively?" Jiang revealed the medicine he took. I asked, "Why act so rashly?" He replied, "I recall my father suffered diarrhea and this medicine was very effective. Why has it worsened in my case?" I explained, "Your father must have been elderly with Qi deficiency and failing Middle Qi control, leading to chronic loose stools; thus, ascending tonification was effective. You drank excessively, confusing clear and turbid fluids, resulting in urinary obstruction and water exiting via the bowels. Immediate treatment should promote drainage, not ascent. If the bowels remain blocked, abdominal distension and body swelling will result, forming a major syndrome." I sent a servant to buy Weiling Wan (Stomach-Ling Pills, a combination of Pingwei San and Wuling San), two liang, to be taken with ginger water. The next day, urination resumed. The following day, watery diarrhea stopped.
Cold Hernia Caused by Liver Qi Condensation
Chang Shao Zhang Bingtang, a fellow townsman, contracted hernia disease in the Jiayin year. His scrotum felt heavy and dragging, and his bladder occasionally pained. He happened to be on duty at Yuanmingyuan. The road out of the city gate was paved with stone, extending tens of li. Carriages tilted, forcing passengers to support themselves with all their strength, which many found painful. After one round trip, Bingweng's hernia pain intensified, and his scrotum threatened to swell. He consulted a doctor, who, in haste, did not inquire carefully. The doctor said, "Scrotal swelling is mostly due to damp-heat sinking downward; promoting urination and clearing fire will remove the pain." Bingweng, ignorant of medical nuances, eagerly took the medicine. The pain increased severely, making waist and hypochondriac movement impossible. He then asked me to examine him. His pulse was deep and slow, with nodularity at the costal margin, moving straight up and down. I said, "This is Cold Hernia. The pathology is Liver Qi condensation. The hypochondrium feels like a pillar. It requires warming the blood and nourishing the hypochondrium. Promoting urination and clearing fire will only increase the severity." I compounded a batch of Huixiang Wan (Fennel Pills) for him. After taking less than one liang, the pain decreased. Soon after, he received an appointment as Inspector of Studies in Shengjing (Shenyang) and packed to leave the pass. In winter, he wrote, "The medicine is finished, and the hernia has not recurred. I continue to follow your advice of warming and nourishing."
Yin Deficiency with Internal Heat and Spleen Injury Leading to Spitting of Blood