同年娄丙卿，壬子捷南宫（礼部考试告捷），得庶常（官名），亦寓于三忠祠。素有唾血疾，人不知也。一日宵坐，其仆携汤药来饮之。因问君何病，所服何药。丙卿曰：弟有血疾，经数年矣，医药不啻百辈，竟无效。昨遇医士，以为肺金受火伤，赐一方服之。虽不甚效，然尚平平无大误，弟觉病非旦夕病，故药亦无旦夕效也。余请一诊视，丙卿曰，润翁解此乎？相处不知，几交臂失之。乃伸其腕，觉六脉沉细而数，脾部尤甚，而肺部却浮短而涩，非病脉也。乃告曰：君所患为阴亏生内热，兼思虑伤脾，脾不统血，故午后有时发热，水泛为痰，或梦遗失精，怔忡惊悸，然否？丙卿曰，所言之证，无毫发差，当作何治？乃视其所服之方，则救肺饮也。告曰，君病在脾肾两经，与肺并无干预，果肺病，当喘咳。君不喘咳，而以紫苑、兜铃凉之，是诛伐无过也。久而肺寒气馁，则成瘵矣。此时夏令，宜常服麦味地黄丸。令金水相生，水升火降，血亦当少止。秋后以人参归脾丸摄之，不过二斤，保无病矣。丙卿乃买麦味丸服之。五日后，热退神清，唾少止，继以归脾丸。至仲秋后分手时，则血全止而无病矣。次年散馆作武邑宰，秋寄函问余，有曰：自服君药，顿去沉疴，怀念良朋，时形梦寐，每公余独坐，犹忆握腕清谈时也。余复谢焉。
少司成马介樵所狎伶人（戏子）名阿二，秋后发疟疾，寒多热少，精神困惫。介翁亦知医，云是虚寒，施桂附补之，疟不少减，而转寒为热，发则烦渴汗出。一日有友人在吟秀堂招饮，介翁命呼阿二车载以来，则坐立不能自主。介翁云：今日招尔非为侑酒，王老精于医，拟令去尔病也。阿二请安将叩头，余日：病体如此，何必拘拘。诊其脉，则浮而缓，沉取之，内甚实。乃告介翁曰，疟疾是外感病，阿二内有积热，外伤于风，须先解其表，后清其热。用桂附似未当，乃命服五积散（方：白芷川芎甘草当归肉桂芍药半夏陈皮桔梗麻黄苍术干姜厚朴枳壳生姜）。以桂枝易麻黄。二日疟少止，而烦渴依然，又进以桂枝白虎汤，十日而全清矣。后在文昌馆文宴，阿二在三庆部，晚饭后，专为余演桂花亭一折。情深文明，的是佳剧。后余呼之必来，虽极忙促时，必勿勿一至也。
商人某，不知姓名，亦西人，在质库为经纪。秋后疽发于背，延医治之未效也。一日其弟专车到门叩头迎余。问何病，则曰：背疽。余以医疡甚污秽，辞以不能外科，宜请专门名家治之。其弟曰，已请疡医数辈，俱曰阴症不能治，念兄弟零丁，千里投商于京，兼获利无多，倘有不测，骸骨亦难归里，请君一视以决之，必不可为，亦不怨也。余以情词哀切，至，则肺俞处，溃烂口如茶碗大，不红、不肿、不痛，肉色带青，流出粘黄水，非脓、非血。而病人昏昏欲睡，精神全无。余曰，疡医谓是阴症，良不谬。然转阴为阳，尚有方术，何竟无知之者。其弟急请之，余曰，此病余实不能动手，况此时外冶亦无益，须建中提气，觉肿痛则有望矣。乃开补中益气汤，重用参芪，并加桂附干姜命服之。越二日，其弟又来曰，家兄疽已红肿，精神顿生，饮食小进，请施外治。余辞曰，外治则吾不能，宜仍请前外科家治之，彼能动手，必无虑矣。乃延前疡医敷药去腐，凡二日一洗涤，半月后疮合而俞。
里中段某之妻，年廿余，忽患昏乱，浑身颤汗，口蹇不能言，腹中满闷，颠倒欲绝。其家以为祟，招女巫驱之。女巫多索粟帛，用香褚祈禳之，病不减。三日后，求余视之，诊其六脉乱动，沸如泉涌，且手足乍屈乍伸，不可把握。乃告之曰，此风痰也。少年气盛，下之则愈。乃命服祛风至宝丹（滑石川芎当归甘草白芍防风白术石膏黄芩桔梗熟地天麻人参羌活独活栀子连翘薄荷麻黄大黄芒硝川连黄柏细辛全蝎）。至晚则大便出红黄秽物数筒，次早而安。又请往视，六脉俱平，神气清爽。告曰，病已去，不必服药，但避风寒，节饮食，不久痊愈。半月后酒肉来谢，余知其贫，却之。
友人盂嘻之妻，年四十余，新产后，患腹中块痛。延余诊视，按其两脉实大而坚，知非吉象，而以至好，不便明言。乃聊以人参泽兰汤进，服之未效。又请余冶，余曰，痛不减，则药不效，请延他医视之。盂不肯，至余门者日三四次。不得已，实告曰，产后之脉，宜缓宜小，今见坚大，恐难愈也。盂曰：试再进一方，万一不愈，亦不敢怨。余曰：岂在怨不怨，但竭力经营，徒费钱无益耳。盂忧疑而去。凡更十数医，无毫发效，五十余日而殁。
内人之妹适武举张某之长子，产后患心胃痛。发则饮食俱绝，气促口干。其翁延人视之，皆曰虚，况产妇尤无实症，当培其气血，气血流通，则痛止。始服八珍汤，继服十全大补汤，月余不止。乃来外家求余治。诊其左寸关脉，坚凝而涩，知为瘀血停于胸膈。乃曰，胸膈痛，非心胃痛也。发则内如针刺，口渴气喘，宜散瘀以定痛，不宜补气以益瘀也。前服多补药，何能有效。乃命服失笑散二剂，而痛若失。三日后视之，则其儿始岁余，手足发热，神痴气粗，乳食不进，喉中时时如锯声，众以为惊风，延一邻媪针灸之。余曰：此痰也，针灸则益甚，必平日多置暧处，其母卧而乳之所致也。瞩服白玉饼（方：滑石半夏巴霜朱砂苦矾各一钱神曲糊为丸，滑石为衣）数粒，至晚则下绿色粪如许，乳食进热退而安。后返其家未逾月，乃婿忽来，下车入门，面目黑腻，胸高气喘。问系吐血疾，自言心中时时作呕，两胁刺痛发咳。来求治之。诊其脉弦而滑，乃曰：此气秘也，必有大遂事，暴怒伤肝，乃致是疾。张曰：然。余曰：曾施治否？张曰：有村医以余为阴亏，命服地黄汤，转增腹张，乃辞，而求阁下。余为开苏子降气汤，又开逍遥散方，付之曰：路远病劳，归先服降气汤，气当舒，再服逍遥散，血当止，十数日保无恙，无烦再来也。张谢而去，如言服之，月余，遣人来言，主人病痊愈，恐在念，令小人先告知，有暇必衣冠来谢也，余固止之。
同谱王丹文茂才之父，余执子侄礼，少游江湖，权子母，工于心计，故握算持筹资无少缺。晚年出资在永宁州生息，忽为典商负千金，州郡控诉，未获归赵，忧郁而病，兼家务多舛，遂得气逆症。腹满身痛，转侧不安。他医投补剂，转增剧。丹文邀余诊视，其脉多伏，惟肝部沉坚而涩，且三二至辄一息。知力肝郁，因以苏子降气汤合左金丸进，三服而气稍舒。又视之，肝部有长象，又益颠倒木金散进之，十剂后，腹减而气舒，饮食进，精神作矣。一日留晚餐，座中仍令诊之，脉息如故，余未便明言，归语家人云：三伯肝脏已绝，病恐不起。家人曰，已愈矣，何害？余曰，此脉不关此病，此病易愈，此脉不可转也。况见肝脏，必死于立春前后。家人以余故神其说，置不信，余遂北上。至冬病作，竟医药无效，于腊月廿四日终于家。余由京归，家人语其事，咸诧异焉。
热郁伤暑误用桂附
丙辰春，余需次入秦，西安守沈小梅，余内阁前辈也。时税骖，即召余入谳局，昕夕相从，蒙其奖拔，信足感也。是年至四月不雨，至于六月旱甚，大吏忧之，谋所以祈雨者，星甫年伯以八卦坛进。遂延僧道数十人讽经设醮。派余及州县数人监其事。小梅素壮，自是夙兴夜寐，奔走不惶，兼旱天酷暑，事务增烦，遂得热病，烦躁不安，精神昏瞀。余在雨坛未知其事，越日，小梅不来，问两首县则曰：太尊病两日矣。问何病，两县不能悉言。次候补府何保如仆从而来曰：小梅之病甚危，外似实症，内实虚寒，已进桂附理中汤，不知可获效否？因问其脉，保如以微对。余心窃以为不然。而未知形症，不敢辨也。盖小梅浙人，保如亦苏产，恐俗医误事，故延保如治之。次日，星甫惶恐而来曰，小梅病危在旦夕，昨服药后，益僵不能动，仅存余息而已。余告同人恐不至此，小梅病当是药误，急登舆而视之。至署，则阁家环泣，幕僚咸啧啧耳语。余急止之曰：病才数日，未必不可治，请一视之。其子似竹，急揖余曰：老伯既解此，宜施拯救，前实不知。随入视之，小梅横卧，呼之不知，面汗出如油腻，气息粗急，视其腹，浑身如赤，按之鼓甚，且鼻有血涕，两目白珠全红，口吻肿破，舌强不可卷伸。问饮食乎？曰，不食三日矣，惟饮水而嫌热。问二便乎？曰，点滴全无。诊其脉则丝毫不见，而血络棱起带紫色。乃告其家人，此实热内郁，外伤于暑。保翁误认为虚寒，投以桂附，若再服，则九窍出血，遍体紫黑而毙矣！幸气息尚盛，虽危尚可治，勿忧也。为立一方，以大承气汤，白虎汤，六一散合之。其幕孙桂珊曰：南人畏大黄石膏如鸠毒，今用至数两之多，恐虎狼之性戕人命也？余曰，病势至重，轻剂断不能达。孙曰，南人脾胃虚弱，不比北人强壮，宜少减之。余不得已请之曰：古人留石膏大黄专为北人耶？抑为天下后世耶？君如此多疑，以为可，则进，不可，则否，余不能误人性命，急拂衣而起。其家见余言激切，急煎服之。而其子留余不使出署，越二刻许，小梅呻吟求凉水，目开而语出。家人禁其饮凉，余曰，尽饮之无伤也，乃饮凉水两碗。刻许，而呼小便，下如血。余曰：何如？至晚，则胸腹雷鸣，下黑粪数十粒，精神渐爽。家人共喜，急告以故，次早肩舆迎余，握余手曰，蒙君再生，感激无既，前药尚可服否？余曰，一服始通，病尚未清，连服三四乃可，君何怯焉。凡五服，而病全除。数日后，小梅问余曰，大黄素实不敢沾口，今借此得愈，深为南人卖。余曰，前辈固南人，而京居十数年，脾胃亦与北人等。况医之一道，认病为先，不必存南北之见。小梅又欲服参补虚。余曰，本不虚，何容补。如参茸能壮人，则神农，后稷，何不教人食参茸而食五谷乎？小梅拍案曰，痛快之论，得未曾有闻者，咸首肯焉。
小梅之次媳，初秋忽患项脖肿痛，延一医视之曰：此厥阴瘰疠也。外贴羔药，内服疏肝解郁之剂，五六日来并无功效。其夫似竹延余视之，见其高肿焮红，按之坚凝，知非瘰疠。问初发时寒热否？曰，不但寒热，并带头疼，且头目眩掉，时时有汗出。按其脉，两寸浮数。乃曰，此发颐病，并非瘰疠。盖内蕴积热，外伤于风，以致火郁经络，四体不舒，骨节烦痛，若作瘰疠治，失之万里矣。且贴膏敷药，势将破溃，遂至缠绵，愈且无日，急命去其膏，用通草汤洗净，投以连翘败毒饮，越日而痛止，再服而肿消，五日后全清矣。
泾阳令周备三之岳母，并其内嫂，两代孀居，食息仰给于周。一日谳局公退，备三邀余曰，舍亲病甚，乞往视之。余随至其家，问何病？备三曰，家岳浑身发热，烦渴汗出，胸满便闭，腹中增痛。内嫂患肚腹闷胀，有时而痛，不热不渴，四肢无力，精神困倦，饮食不思。余两诊其脉，其岳母则沉而数，右关坚大，其内嫂则六部迟缓，右关尤甚。乃告之曰，二症老少悬殊，老者胃热；少者脾寒。热者宜下；寒者宜温。遂令其岳母服调胃承气汤，其内嫂服桂附理中汤。备三曰，下则用芒硝大黄，补则用肉桂附子，二症虽殊，不该迳庭若此，少缓之何如？余曰，泰水病若实火内攻，缓之恐发狂疾。内嫂脾上弱极，缓之必成泄泻。急救之尚恐不及，况敢犹预。备三曰，唯唯，余辞而出。过数日，问两病何如？备三曰，二病俱有小效，然未全愈。余骇曰，服硝黄而不下，服桂附而不振，难道热者怀铁石？寒者成痨瘵耶？备三笑曰，前日之方，实恐太峻，君去后承气汤去硝黄，理中汤去附子。谚云："当迟不当错，非药不效也。"余曰，令亲何拘之深，药病相投，如机缄之对发，过则为害少则不及，此间分隙不容毫发，何得私意抽添。请照方服之，错则我当之，必无害也，备三乃可原方进。次日其岳母下燥粪，火退而身清矣。其内嫂腹痛递减，饮食少思。又延余往视，余曰，令岳母病已去，不必服药，唯令调摄保无虞。令内嫂则此药非十数剂不可，且须常服温中理脾诸药，方无反复，非旦夕可望也，余辞去。一月后，以宫绢酒点八物来谢，余与备三为莫逆，乃封还之。
备三之夫人，工诗善画，刺绣尤冠一时，人亦风流自喜，词辩滔滔。余在备三处闲谈，诸寅作斗叶之戏，余不喜此事作壁上观，晚餐甫设，有媪自内出，启备三日，太太不知何故，忽患心烦发呕，坐卧不安，闻王大老善医，急请入视。余偕备三入，则二婢扶坐，粉汗淫淫，作捧心状。急诊其脉，脾部细弱，左寸滑数特甚。乃曰，夫人所患是脾虚停痰症也。盖由思虑伤脾，饮食不化，平日必有健忘惊悸之疾。此时痰涎绕心包络，故烦呕交作。须先清其痰，后理其脾。清痰须用莲子清心饮（黄芩麦冬地骨皮车前子甘草石莲子人参黄芪茯苓），理脾须用人参归脾丸。病以渐来，亦以渐去，旦夕难全愈也。乃先以清心饮投之，二日而烦呕止。再进归脾汤，十日而四视之，病若失矣。
气郁喘嗽
Lou Bingqing, a fellow provincial examinee, passed the Ministry of Rites examination in the Renzi year and obtained the position of Shujishi (Junior Editor in the Hanlin Academy). He also resided at the Sanzhong Shrine. He had a long-standing history of hemoptysis (coughing up blood), which others were unaware of. One evening, while he was sitting, his servant brought him herbal decoction to drink. I asked him what illness he suffered from and what medicine he was taking. Bingqing replied: "I have had this blood disorder for several years. I have taken more than a hundred different prescriptions, yet none have been effective. Yesterday, I met a physician who diagnosed my condition as Lung Metal being injured by Fire, and prescribed a formula for me. Although it has not been very effective, it has been relatively stable without major errors. I believe my illness is not something that can be cured overnight, so I do not expect immediate results from the medicine." I requested to examine his pulse. Bingqing said, "Do you understand pulse diagnosis, Master Run? We have known each other for so long, yet we almost missed this opportunity." He extended his wrist. I felt that all six pulses were deep, fine, and rapid, with the Spleen area being particularly prominent, while the Lung area appeared floating, short, and choppy, which is not typical for an acute disease pattern. I then told him: "Your condition is caused by Yin deficiency generating internal heat, compounded by excessive worry injuring the Spleen. The Spleen fails to control the blood, leading to afternoon fever, phlegm formation due to water flooding, nocturnal emission, palpitations, and fright. Is this correct?" Bingqing said, "The symptoms you described are accurate. How should it be treated?" I examined the prescription he was taking, which was Jiufei Yin (Lung-Saving Decoction). I informed him: "Your disease lies in the Spleen and Kidney meridians and has no direct relation to the Lung. If it were a Lung disease, you would present with wheezing and coughing. Since you do not have these symptoms, using cold herbs like Ziwan (Asteris Radix) and Doulou (Fritillariae Thunbergii Bulbus) to cool the Lung is attacking the innocent. Over time, this will lead to Lung Qi deficiency and cold, resulting in consumptive disease (Zhai). Since it is currently summer, you should regularly take Maiwei Dihuang Wan (Lily and Schisandra Rehmannia Pill). This will promote the mutual generation of Metal and Water, allowing Water to ascend and Fire to descend, thereby reducing bleeding. After autumn, use Renshen Guipi Wan (Ginseng and Spleen-Nourishing Pill) to regulate your condition. With about two jin (approx. 1 kg) of this pill, you will be guaranteed health." Bingqing purchased and took Maiwei Dihuang Wan. Five days later, his fever subsided, his spirit cleared, and hemoptysis decreased. He then continued with Guipi Wan. By mid-autumn, when we parted, his bleeding had completely stopped, and he was healthy. The following year, after completing his duties in the Hanlin Academy, he became the magistrate of Wuyi County. In autumn, he sent me a letter saying: "Since taking your medicine, my chronic illness has suddenly vanished. I often dream of our friendship. Whenever I sit alone after official duties, I recall our conversations while holding wrists [pulse diagnosing]." I replied with gratitude.
Malaria Caused by Internal Accumulated Heat and Wind Invasion
The favorite actor named A'er, belonging to Ma Jieqiao, the Vice Director of Studies, contracted malaria after autumn. He experienced more chills than fever and was mentally exhausted. Master Jie, who also understood medicine, diagnosed it as deficiency-cold and administered Cinnamon Twig and Aconite (Guizhi and Fuzi) to tonify. The malaria did not subside significantly; instead, it transformed into a pattern with less chills and more fever, accompanied by irritability, thirst, and sweating during attacks. One day, a friend invited Master Jie to drink at Yinxiu Hall. Master Jie ordered A'er to be brought by cart, but he could neither sit nor stand independently. Master Jie said, "I did not invite you today for entertainment. Master Wang is skilled in medicine and intends to cure your illness." A'er bowed to greet me. I said, "Given your condition, there is no need for rigid etiquette." Upon examining his pulse, it was floating and slow, but firm and excess upon deep pressure. I told Master Jie, "Malaria is an exogenous disease. A'er has accumulated heat internally and is externally affected by wind. The exterior must be resolved first, followed by clearing the internal heat. Using Cinnamon Twig and Aconite is inappropriate." I prescribed Wuji San (Five Accumulations Powder: Bai Zhi, Chuan Xiong, Gan Cao, Dang Gui, Rou Gui, Shao Yao, Ban Xia, Chen Pi, Jie Geng, Ma Huang, Cang Zhu, Gan Jiang, Hou Po, Zhi Ke, Sheng Jiang), substituting Guizhi (Cinnamon Twig) for Ma Huang (Ephedra). After two days, the malaria subsided slightly, but irritability and thirst persisted. I then administered Guizhi Baitou Tang (Cinnamon Twig and White Tiger Decoction). After ten days, he was completely cured. Later, at a literary banquet at Wenchang Pavilion, A'er, performing with the Sanqing Troupe, specifically performed the scene "Guihua Ting" (Osmanthus Pavilion) after dinner. His performance was deeply affectionate and elegant, truly a fine drama. Whenever I summoned him afterwards, he would come, even if busy, making a point to visit briefly.
Yin Abscess on the Back
A merchant, whose name is unknown and who was a Westerner, worked as a broker in a pawnshop. After autumn, an abscess developed on his back. Medical treatment yielded no effect. One day, his brother arrived by special carriage, kowtowed at my door, and invited me. When asked about the illness, he replied, "Back abscess." I declined, stating that treating sores is messy and that I am not a specialist in surgery, suggesting he seek a renowned surgical expert. His brother said, "We have consulted several surgeons, all of whom said Yin-type sores are incurable. Considering my brother is alone, having traveled a thousand li to trade in the capital with little profit, if anything happens, his remains may never return home. Please examine him to decide if it is treatable. If it is indeed hopeless, we will not resent you." Moved by his earnest plea, I went. At the Feishu acupoint area, there was an ulceration the size of a tea bowl, without redness, swelling, or pain. The flesh color was bluish, oozing sticky yellow fluid, neither pus nor blood. The patient was drowsy and lacked spirit. I said, "The surgeons correctly identified this as a Yin syndrome. However, transforming Yin to Yang is still possible. Why are there no knowledgeable practitioners?" His brother urgently requested help. I said, "I cannot perform external treatment myself, and external therapy is of little benefit at this stage. We must strengthen the Middle Jiao and raise Qi. If swelling and pain develop, there is hope." I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), heavily dosed with Renshen (Ginseng) and Huangqi (Astragalus), plus Rougui (Cinnamon Bark), Fuzi (Aconite), and Ganjiang (Dried Ginger). Two days later, his brother returned, saying, "My brother's abscess is now red and swollen, his spirit has revived, and he is eating slightly. Please apply external treatment." I declined, saying, "I cannot do external treatment; please consult the previous surgeon. He can handle it safely." The previous surgeon was engaged to apply medication to remove necrotic tissue, with cleansing every two days. After half a month, the wound healed.
Wind-Phlegm Confusion
The wife of Duan from Li Zhong, in her early twenties, suddenly suffered from confusion, whole-body tremors and sweating, slurred speech, abdominal fullness, and extreme distress. Her family attributed it to demonic possession and hired a female shaman to exorcise it. The shaman demanded much grain and silk, burning incense and praying, but the illness did not improve. Three days later, they sought my help. Her six pulses were chaotic and surging like a spring, and her limbs flexed and extended irregularly, making them difficult to grasp. I told them, "This is Wind-Phlegm. In young people with vigorous Qi, purgation leads to recovery." I prescribed Qufeng Zhibao Dan (Wind-Expelling Precious Pill: Shi Huai, Chuan Xiong, Dang Gui, Gan Cao, Bai Shao, Fang Feng, Bai Zhu, Shi Gao, Huang Qin, Jie Geng, Shu Di, Tian Ma, Renshen, Qiang Huo, Du Huo, Zhi Zi, Lian Qiao, Bo He, Ma Huang, Da Huang, Mang Xiao, Chuan Lian, Huang Bo, Xi Xin, Quan Xie). That night, she passed several tubes of red and yellow foul stool. By the next morning, she was calm. Upon re-examination, her pulses were level, and her spirit was clear. I said, "The illness has passed; no further medicine is needed. Avoid wind and cold, regulate diet, and she will recover soon." Half a month later, they brought wine and meat to thank me. Knowing their poverty, I refused.
Abdominal Pain Postpartum
The wife of my friend Meng Xi, over forty years old, suffered from mass-like abdominal pain shortly after childbirth. Upon examination, her pulses were large, firm, and hard, indicating an unfavorable prognosis. Due to our close relationship, I did not state this openly. I tentatively prescribed Renshen Zelan Tang (Ginseng and Landolphia Decoction), but it was ineffective. She visited me three to four times daily, insisting on treatment. Reluctantly, I told her husband frankly: "Postpartum pulses should be slow and small. Seeing large and hard pulses suggests difficulty in recovery." Meng said, "Try another prescription. If she does not recover, I will not blame you." I replied, "It is not about blame. I will try my best, but it may be futile and costly." Meng left worried. Over ten physicians were consulted with no effect. She died after fifty-plus days.
Three Cases: Postpartum Chest Pain, Infant Phlegm Disease, and Liver Injury from Violent Anger
My wife's sister married the eldest son of Military Graduate Zhang. Postpartum, she suffered from heart and stomach pain. During attacks, she could not eat or drink, and experienced shortness of breath and dry mouth. Her father-in-law consulted physicians, who all diagnosed deficiency. Given that postpartum women rarely present with excess patterns, they recommended tonifying Qi and Blood. She took Bazhen Tang (Eight Treasures Decoction) initially, followed by Shiquan Dabu Tang (Ten Great Tonifying Decoction), but the pain persisted for over a month. She then came to my residence for treatment. Her Left Cun and Guan pulses were firm, congealed, and choppy, indicating blood stasis stagnating in the chest and diaphragm. I said, "This is chest/diaphragm pain, not heart/stomach pain. The sensation is like needle pricks internally, with thirst and panting. It requires dispersing stasis to stop pain, not tonifying Qi which would exacerbate the stasis. Previous tonics were ineffective." I prescribed Shixiao San (Pain-Dispersing Powder) for two doses, and the pain vanished. Three days later, I visited her infant, who was just over one year old. The child had hot hands and feet, dull spirit, coarse breathing, refusal of milk/food, and a sawing sound in the throat. Others suspected convulsions and hired a neighbor for acupuncture. I said, "This is Phlegm. Acupuncture will worsen it. It is likely caused by keeping the child in warm places too much and breastfeeding while lying down." I instructed giving Baiyu Bing (White Jade Cake: Shi Huai, Ban Xia, Ba Shuang, Zhu Sha, Ku Fan, Shen Qu) for a few pills. That night, the child passed green stool, resumed feeding, and the fever subsided. Less than a month later, the son-in-law Zhang came to me, looking dark and greasy, with chest distension and panting. He reported hemoptysis, nausea, stabbing pain in both hypochondria, and cough. His pulse was wiry and slippery. I said, "This is Qi constipation, likely due to severe constipation. Violent anger injured the Liver." Zhang confirmed this. He mentioned a village doctor had diagnosed Yin deficiency and prescribed Dihuang Tang (Rehmannia Decoction), which increased abdominal distension. I prescribed Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction) and Xiaoyao San (Free and Easy Wanderer Powder). I advised: "Travel is arduous; take the descending Qi decoction first to soothe Qi, then Xiaoyao San to stop bleeding. You will be safe in ten days; no need to return." Zhang thanked me and left. A month later, he sent word that his master had recovered. I firmly declined his formal thanks.
Liver Qi Stagnation and Reversal with Pulse Discrepancy
The father of Wang Danwen, a local scholar, was a relative by marriage whom I respected as an elder. He traveled widely in his youth, dealt in loans, and was shrewd in calculations, ensuring ample funds. In his later years, he invested in Yongning Prefecture, but lost a thousand taels to a pawnbroker. Legal disputes ensued without recovery. Depressed and troubled by household affairs, he developed Qi reversal syndrome: abdominal fullness, body pain, and restlessness. Other doctors prescribed tonics, worsening his condition. Wang Danwen invited me to diagnose. His pulses were mostly hidden, except for the Liver area which was deep, firm, and choppy, with only two or three beats per breath. I diagnosed Liver Qi stagnation and prescribed Suzi Jiangqi Tang combined with Zuojin Wan (Left Metal Pill). After three doses, his Qi relaxed slightly. Upon re-examination, the Liver area showed a long pulse shape. I added Diandao Mujin San (Inverted Wood-Metal Powder). After ten doses, abdominal fullness decreased, Qi relaxed, appetite improved, and spirit revived. One evening, during dinner, I examined his pulse again, which remained unchanged. I did not speak publicly but told my family later: "Third Uncle's Liver essence is exhausted; the illness is likely fatal." My family said, "He has recovered, what harm?" I replied, "This pulse does not match the current illness. The illness is easy to cure, but this pulse is irreversible. With this Liver pulse, death is expected around the Start of Spring." My family dismissed my words as superstition. I then traveled north. In winter, the illness recurred, unresponsive to medicine, and he died on the 24th of the 12th lunar month. Upon my return from Beijing, my family recounted the event, and everyone was astonished.
Heat Stagnation and Summerheat Injury Misdiagnosed as Cold, Treated with Cinnamon and Aconite
In the spring of Bingchen, I waited for a post in Shaanxi. Shen Xiaomei, Governor of Xi'an and a senior colleague from the Grand Secretariat, hosted me in the judicial bureau. We spent mornings and evenings together, and I appreciated his patronage. That year, it did not rain until April, and drought was severe by June. High officials worried and planned prayers for rain. Nianbo Xingfu proposed setting up a Bagua Altar. Dozens of monks and Daoists were invited to chant scriptures and hold rituals. I and several prefecture/county officials were assigned to supervise. Governor Shen, usually robust, rose early and slept late, running about tirelessly. Combined with the intense summer heat and heavy duties, he contracted a heat illness: irritability, restlessness, and mental confusion. Unaware of this while I was at the Rain Altar, the next day Shen did not appear. Asking the two chief magistrates, they said the Governor had been ill for two days but could not specify the illness. He BaoRu, a waiting prefect, arrived with his servant, reporting Shen's critical condition: externally resembling excess, internally actually deficiency-cold. They had already administered Guifu Lizhong Tang (Cinnamon, Aconite, and Spleen-Tonifying Decoction) and wondered if it would work. I asked for the pulse; BaoRu described it as faint. I privately doubted this but dared not argue without seeing the signs. Shen was from Zhejiang, and BaoRu from Suzhou; perhaps local doctors were mistaken, hence the choice. The next day, Xingfu arrived anxiously, saying Shen was dying. After taking the medicine, Shen became stiff and could barely breathe. I told my colleagues it shouldn't be this bad; Shen's illness was likely iatrogenic. I hurried to visit. At the yamen, the family was weeping, and staff whispered. I silenced them: "Illness for only a few days; it may still be curable. Let me see him." His son, Si Zhu, urged me to save him. Inside, Shen lay horizontally, unresponsive. Sweat on his face was oily. Breathing was coarse and urgent. His abdomen was distended and drum-like. His whole body was red. Nosebleeds and bloody nasal discharge occurred. Sclerae were fully red. Lips were swollen and cracked. Tongue was stiff and immobile. He had not eaten for three days, only drinking water but finding it too hot. No urine or stool for days. Pulses were imperceptible, but blood vessels were prominent and purple. I told the family: "This is Excess Heat stagnating internally, complicated by external Summerheat. Dr. Bao misdiagnosed it as deficiency-cold and gave Cinnamon/Aconite. If continued, nine orifices will bleed, body will turn purple-black, and death will ensue. Fortunately, Qi is still strong; though critical, it is treatable. Do not worry." I formulated a prescription combining Dachengqi Tang (Major Order the Qi Decoction), Baitou Tang (White Tiger Decoction), and Liuyi San (Six-to-One Powder). Staff member Sun Guishan objected: "Southerners fear Da Huang and Shi Gao as poison. Using several taels risks killing him with tiger/wolf nature!" I replied, "The illness is severe; mild doses cannot reach it." Sun argued: "Southerners have weak spleens/stomachs compared to Northerns; reduce the dose." I insisted: "Did ancients reserve these herbs only for Northerns? Or for all humanity? If you doubt, proceed or stop, but I will not risk lives." I left angrily. Seeing my resolve, the family brewed and administered the medicine. Si Zhu detained me. After two quarters, Shen groaned, asking for cold water, opened his eyes, and spoke. Family forbade cold water. I said, "Drink freely, it will not harm." He drank two bowls of cold water. Shortly after, he urinated blood-like fluid. I asked, "How is it?" That night, thunderous sounds in chest/abdomen, passing dozens of black stools. Spirit gradually refreshed. Family rejoiced. Next morning, they welcomed me, holding my hand: "You have given me new life. Can I continue the medicine?" I said, "One dose opened the bowels; illness not cleared. Take 3-4 consecutive doses. Why hesitate?" After five doses, the illness completely resolved. Days later, Shen asked: "I never dare touch Da Huang, yet I recovered thanks to it. I owe you, Southerner." I replied: "Though you are Southern, living in Beijing for years, your spleen/stomach are like Northerns'. Medicine prioritizes accurate diagnosis; regional bias is unnecessary." Shen wanted to take Ginseng to tonify deficiency. I said, "There is no deficiency; why tonify? If Ginseng/Rhino Horn strengthened people, why didn't Shennong and Houji teach people to eat them instead of grains?" Shen slammed the table: "Brilliant argument! Never heard such logic before." All nodded in agreement.
Parotitis (Fa Yi)
Governor Shen's second daughter-in-law suddenly developed neck swelling and pain in early autumn. A doctor diagnosed it as Jueyin Scrofula (Luoli). External plaster and internal Liver-soothing/depressant formulas were used for five-six days with no effect. Her husband, Si Zhu, invited me. I saw high swelling, redness, and hardness, ruling out scrofula. I asked if chills/fever occurred at onset. He said, "Not only chills/fever, but also headache, dizziness, and frequent sweating." Pulses at both Cun positions were floating and rapid. I said, "This is Fa Yi (Parotitis), not scrofula. Internal accumulated heat, external wind invasion, causing fire stagnation in meridians, limb discomfort, bone/joint pain. Treating as scrofula is a grave error. Plasters will cause rupture and chronicity. Remove plasters immediately, wash with Tongcao Tang (Tetrapanax Decoction), and administer Lianqiao Baidu Yin (Forsythia Detoxification Decoction)." Pain stopped the next day, swelling subsided after another dose, and complete recovery occurred in five days.
Stomach Heat and Spleen Cold
Zhou Beisan, Magistrate of Jingyang, invited me to treat his mother-in-law and sister-in-law (both widows dependent on Zhou). At the yamen, he said his relatives were very ill. I went to his home. Zhou explained: Mother-in-law has whole-body fever, irritability, thirst, sweating, chest fullness, constipation, and increasing abdominal pain. Sister-in-law has abdominal bloating/pain, no fever/thirst, weak limbs, fatigue, and poor appetite. I examined pulses: Mother-in-law's pulse was deep and rapid, Right Guan firm and large. Sister-in-law's pulses were slow throughout, especially Right Guan. I said: "The patients differ greatly in age. Elder has Stomach Heat; younger has Spleen Cold. Heat requires purgation; Cold requires warming." I prescribed Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) for the mother-in-law and Guifu Lizhong Tang (Cinnamon, Aconite, and Spleen-Tonifying Decoction) for the sister-in-law. Zhou questioned: "Using Mangxiao/Dahuang for purgation and Rougui/Fuzi for tonification seems drastic. Can we wait?" I warned: "If Mother-in-law's excess fire is delayed, madness may ensue. Sister-in-law's Spleen weakness is extreme; delay will cause diarrhea. Urgent rescue is necessary." Zhou agreed, and I left. Days later, Zhou reported slight improvement but no full recovery. I was shocked: "Taking Mangxiao/Dahuang without purging, Guifu/Lizhong without warming? Does the hot one hold iron stones? Does the cold one become consumptive?" Zhou smiled: "I feared the prescription was too harsh. After you left, I removed Mangxiao/Dahuang from Chengqi Tang and Fuzi from Lizhong Tang. Proverb says: 'Better to delay than err; if medicine fails, it's not the fault.'" I replied: "Why such caution? Medicine must match the disease precisely, like lock and key. Too much harms, too little fails. No room for personal modification. Please follow the original prescription. If wrong, I accept responsibility; it will be harmless." Zhou agreed. Next day, mother-in-law passed dry feces, fever subsided, body cleared. Sister-in-law's abdominal pain decreased, appetite slightly improved. I revisited: "Mother-in-law is cured; no more medicine, just care. Sister-in-law needs many doses of this medicine and regular warming/Spleen-regulating herbs to prevent relapse; quick recovery is unlikely." I left. One month later, they offered gifts. As Zhou and I were close friends, I returned the gifts sealed.
Worry Injuring Spleen, Phlegm Disturbing Pericardium
Madam Zhou, wife of Beisan, was talented in poetry, painting, and embroidery, elegant and eloquent. While chatting at Beisan's house, watching guests play cards, I declined to join. Dinner was just set when an old woman emerged from inside, telling Beasan: "Madam suddenly feels irritable, nauseous, restless, unable to sit or lie comfortably. Heard Master Wang is a great doctor; please invite him quickly." I entered with Beisan. Two maids supported Madam, who was sweating profusely, holding her chest. I urgently examined her pulse: Spleen area fine and weak; Left Cun slippery and rapid. I said: "Madam suffers from Spleen Deficiency with Phlegm retention. Worry injures the Spleen, food fails to transform. She likely has habitual forgetfulness and palpitations. Now phlegm surrounds the Pericardium, causing irritability and vomiting. Clear phlegm first, then regulate Spleen. Use Lianzi Qingxin Yin (Lotus Seed Heart-Clearing Decoction: Huang Qin, Mai Dong, Di Gu Pi, Che Qian Zi, Gan Cao, Shi Lian Zi, Renshen, Huang Qi, Fu Ling) to clear phlegm, and Renshen Guipi Wan to regulate Spleen. Illness comes gradually, so it leaves gradually; quick recovery is unlikely." I administered Qingxin Yin first. Irritability and vomiting stopped in two days. Then Guipi Tang was given. Ten days later, upon fourth visit, the illness had vanished.
Qi Stagnation with Wheezing and Cough