里中钮某之妻，体素壮，忽患月事不至。始以为胎。久而腹痛，又以为虚，补之益甚。留连数月，腹大如鼓，饮食不思。迎余治之。诊其脉，两关坚劲。问发渴乎？曰，前半日多渴，后半日方可。余曰，此胃热血结也。寻常必患胃热，发则胸膈如烧，甚则发咳，痰必稠。病者曰，良是。先以三黄四物汤破之，二服后下紫块十余，腹少减。又以两地地黄汤加山栀、连翘、通草，叠进之。逾月而潮至，然前后尚不齐也。命常服归芍地黄汤，数月后，如期血至，久而受孕矣。
邻人郭某之女，再醮于邻村，归宁恒数月不返。一日忽患咳嗽，初略不为意，久而增盛，延人治之，则曰，此虚劳也。始而补气，继而行瘀，又转而理脾疏肝。药屡易而病不减。一日其母偕之来，俯余治。因问曰，嗽时作时止乎？抑咳则面赤气急声声接续乎？曰急甚。观其面色红润，知非虚证。乃诊其脉，则右寸浮滑而数，余则平平。告曰，此痰火郁在肺经，常苦胸膈满闷，发则痰嗽俱出，不但非虚劳，且大实热证也，进以芩连二陈丸加桑皮，木通以疏之，三日而嗽减。再请余治，则数象减而滑则依然。余曰，热退而痰仍在，不去之，恐复作，因用平陈汤加枳实大黄下之。凡二进，下顽痰数碗胸膈顿宽，而嗽亦止矣。
咳嗽一症，风寒暑热，饮食郁滞，思虑劳倦，皆能致之。医宗必读阐内经之旨，讲此症最为详尽，学者当究心，若一概施治，未有不致悖谬者。
同乡郝某号秀山，在都作银商，自秋发嗽至十一月，数医之尚未愈也。余侨寓襄陵馆，与郝某素昧生平。一日梁某偕之来求余治，问何病？对以咳嗽四月矣。问，曾治否？对以药以百计而嗽如故。言次探手于怀，出药方隆然一裹。细检之，皆参苓芪术等类。盖郝素弱，又富于财，俗医皆作虚论也。乃诊之，余平平，肺独浮滑。告之曰，浮者风象，滑者痰象。君素积痰，复感于风，风痰相搏，而嗽作矣。又以参芪固其腠理，腠理不开，风无去路，嗽何时已乎。数药可愈，郝见余言易，进曰，年少时有唾血疾，体本虚，故畏克伐药。晓之曰，此他医之所以用参芪也。要知少年唾血，未必虚证。即虚，而此时血止而嗽作，医不治嗽而治血，请问君见我为冶嗽乎?为治血乎？病者笑而是之。乃以杏苏饮加山楂，枳实进。嘱曰，不过五服病必愈，无烦再来也。病者持而去，越五日，投帖请余观优戏，晚则筵席丰隆，殷勤周至。时余方以分发赴秦，因遣其同类，随之到秦，开设银肆，听昔过从称莫逆焉。
忧郁致疾腿目渐废
李莲芳茂才，少与余共笔砚，后以童军屡蹶，商于楚。后失业归，复矢志功名，遂入县痒。莲芳少失怗恃，三娶而仍鳏，茕无子嗣。丙辰余自京归，已败累矣。以忧郁故，腿渐废，目渐瞀。然步履出入，尚可作字，悯其贫，携之入秦，经理馆事。继，余以内艰旋里，念莲芳无依，因荐于朝邑主薄冯子安作幕，冯亦同乡，又杂职，莲芳虽非素优，然小心持算，无不井井有条，宾东相得。而莲芳私念年逾五旬，妻子全无，顾影增凄，倍形忧郁，明年秋，单车而归。余以为宾东不合，急视之，则莲芳两目起外翳，腿迟重不可曲伸，且冯以缺瘠告病，不得不归矣。因求余治其目与腿。余诊之，心肝弦急，两尺似有似无。仓卒难显言，因劝旷怀自慰，病非旦夕可疗，静心凋摄数月，再作计议。莲芳听之，而家计寥寥，益不自释，目益盲，腿益滞。
有赵城眼医，名家也．一年来介两次，凡外障虽数年，无不针之而愈者。余甚佩服。急请视莲芳眼。医审视之曰，障皮尚嫩，恐不胜针，再数月，皮厚色苍，一拨而去矣。眼医出告余曰，瞳仁已坏，治之亦断不效，不如听之。前乃托言耳。半年许，果殁。余挽一联云："君罪伊何，乃如左邱盲目，孙子病足。天心莫测，竟使黔娄失妇，伯道无儿。
阴火大炽清下无功
病之奇，有不可解者，徒执方药论之，辄不效。同谱弟王丹文之母，春仲忽患热，口渴神昏，发晕出汗，热如火，几发狂。其母家弟以茂才业医，视之知为热。曰，此阳明正病也。投白虎汤用石膏至一两，而热如故。又有邻人李茂才亦业医，用承气汤下之，二便少利，而热如故。丹文邀余往视，按其脉极沉数，知阴火大炽，而肠胃燥甚。告丹文曰，中无实物，火热熏心，下之无可下，宜清降之。急用地黄汤加山栀，三黄进。药服而心颇清，热如故。是夜忽大雪，天甫明，病者知之，要食雪。丹文以其年老，靳不与。逾时，丹文外出，匍匐出户，就阶取雪，卧啖之，凡三碗许，觉心境顿清；又啖之，归而卧于床。至夕则热退身凉，越日而起。三日后，病若失矣。噫！药则罔效而天降雪以除其病。盖雪阴寒，不假烟火，较药之清降胜万倍矣。医家无此法，亦不敢用也。
风寒水肿误作虚治
谚云："老医少卜"殊未必然。盖此事全关天资学力，资质清者，读书多，则虽少亦佳，资质浊者，胸中无物，老而亦愦愦也。辛酉春正月，家君体素壮健而年过七旬。以新年酬应劳攘，且多食厚味，又年前偶感风寒，痰咳流连。上元后，口下暴肿，渐而两足增胀，渐而两手亦胀矣。堉屡欲施治，而家君素不服药，自以体壮，俟其病之自已也。越三日更甚，以长媳有小恙，前曾经杨医治之，乃托治媳病，遣人招杨治家君病。下车视之，则须发苍然，步履迟重，戴眼镜矣轮扶杖而入，毫无谦抑态，扬扬睨一切，余唯唯听命，窃意必斫轮手也。茶后以家君病请教，杨曰，脉后再谈，诊之越时许，乃释手曰：年老气虚，宜有此疾。此时宜先补虚，不必治肿。气不虚，肿自已也。余以其统混无头绪。辨曰，经云："水肿初起，目下如卧蚕形。"今家父病适合，似宜先导水，杨怫然曰，治病拘定书本，焉有是处。请服余药，方信余之不谬也。余未便非之，而心窃不谓然，因请一方。乃八珍汤加桂附也，又加陈皮五分，木通三分。云可利水，掉臂而去。知必不效，而家君以其年老，当有确见。药初进而胸腹增满，肿愈甚。不得已，私以杏苏饮加木通牛膝防己各三钱，煎成请家君服，至半夜，则小便五六次，天明腹宽，而肿处作绉形，嗽亦少止矣。家君见药效，连进四服。肿俱消，惟肾囊尚胀，停三日，又以原方加葶苈，二丑进。凡一服，小便洞下十余碗，肾囊如常，而病全息矣。谚之重老医者，以其阅历深，而见闻广，如杨某者，虽松鹤之寿，此事安得梦见乎！
阳虚血热误作痧治
吾里中有口头语，见卧病者，则曰伤寒热病，医者来，则曰汗症也。而不知伤寒与热病二者大相反。盖伤寒，则真伤于寒，须用热散，仲景之法是也。热病，则外而风寒暑热，内而饮食嗜欲，皆能致之。一或不慎，杀人易于反手。春温夏热，河间之法最善。至饮食嗜欲，则合东垣丹溪之法。参而通之，无遗蕴矣。
长媳初入门十余日，得温病。呻吟叫号，反侧不安。因新妇，急告其父。其父延一医来，则吾里中丙午茂才也。幼尝同考试，其人玩世不恭，乡党薄之，颇落拓。虽通医理，而所读不知何书，每治病，药寥寥三四味，皆以分计，故获效甚少。请视长媳，出告余曰，痧也。宜服犀角解毒汤。尚觉近理，急服之，痧未出而热如故。又易一医，乃河南武安药侩也，初解药性，立方字常误，胸无墨水，而治病颇有一二效者。适为邻治病，延之来。诊脉不一刻，即出曰，此是痧症，又兼胃寒，故胸烦作呕耳，须用温散。请其方，则平胃散也。余不欲令服，而家中人皆曰，时医常以误效，请一试之。药入口则热几如狂，昼夜不安。实无可处。余乃入诊之，脉极沉极数，而外症甚险。告其父曰，以弟愚见，当是阴虚血热。此热症，非痧症也。如是痧，流连将十日，何无一点发耶。此虽新来，乃弟儿妇，当以私意治之，倘有误，亲家亦相谅也。其父诺。乃以大剂地黄汤易生地，合三黄汤满饮之。二更许沉沉睡矣。又恐余热未清，加蝉蜕、灯芯，四服而热止，病始安。令常服麦味地黄丸，半月痊愈。
余甥名映昌，以服贾奔走，兼不节饮食，四月忽得斑疾。初斑未清，请董医视之，董以时症兼食，用五积散，病益重，浑身如丹，目睛皆赤。有老女医为人按摩，延视之，知为斑，乃以针刺其舌，又刺其阴而吮之。心稍清，气稍定，而热则如故。余知而省之。见面汗如流，口唇焦破，以为阳明胃热。诊其脉则沉而数。问二便，则小便赤，大便如常。腹亦绵软。知为阴热无可下，宜清之。乃以知柏地黄汤进之。初服而热减，三服而热清。困卧不起，面目黄瘦矣。惟急索食。告之曰，病已去，不必服药，惟饮食宜清淡减少，否则恐复发也，调养一月而安。此亦阴热症也。
同谱王丹文之母，夏月染疫症，留连数月。屡易医，病渐去，而苦发热头痛，胸中烦扰。而性情反复，忽而不服药，亲邻力劝之而不肯也。一日头痛甚，丹文专车迎余，因视其病，以同谱故侄呼余，余亦伯母呼之。再三开导，乃许服药。诊脉则沉数，而肝部涩，左寸微。告丹文曰，此血虚肝郁也。专滋阴以润血，热当已，且"乙癸同源"，血润则肝亦舒，头痛亦当止，乃开归芍地黄汤，加薄荷、山栀以清之。二日后，丹文来，问之，则身凉而头痛止矣。又不服药，余以其病无碍听之。
论人参
曾读纪文达公五种笔记，载有一条，辩论人参。谓关东人参，得东方生发之气，偏于提补；上党人参，得中央土厚之气，偏于培脾，其用颇疏。此语真前人所未发，余尝因而思之，古方所载人参，即上党之潞参也。其时关东未必有参，即有亦未必入中国。
前明，吴守备到辽沈，闻东参能延年益寿，乃服至半斤，遂至腹泻不止，可见关东人参，至明始入中国。明以前所用之人参，即潞参也。不过在前古则潞参皆地中自植，年深日久，其力颇厚；近则以此为利，年年种而收之，其力较薄耳。
本草谓用参多则宣通，少则壅滞，此言尤要。盖草木之性，全以气胜，况参俱甘温，甘温则能滑泻，吴守备之腹泻，盖由于此。不比五谷之性，专有益于脾胃也。
每见近日士大夫家，日日用参，且用东参，以求调养，少则足以减食，多则必致泻腹，亦何惑之甚耶。
余尝本文达公之意，凡气虚而怯，或痘疮危急，平板不起，用东参辄应手而效。治脾胃虚弱，土湿下陷，饮食不思者，专用潞参，以益健运，亦无不验。
每见近世业医者多货药，临一症则用参、用茸，惟恐其药之不售，其罪恶岂浅鲜哉！因附志于此，以为妄而无知者，示之戒焉。
实证似虚
同乡张七兄名守秩，其夫人患痢疾，屡治不效。托其戚梁某转邀余视之，则年五十余，人甚枯瘦。诊其脉，浮数特甚。问发热否?曰，热甚。问，渴否?曰，渴甚。余曰，若然，则腹必胀痛也。曰，然。乃告张曰，外似虚，却是实证，非下之不可。张不然其说，曰，体素虚，况痢则愈虚，再下之恐不相宜，万一病不可补，微利之可乎?余告以利之无益，若再迟数日，恐内蕴攻胃，成噤口也。张不得已，嘱余开方。余以大承气汤进。归经数日，又请往视，余曰，此病当大效，何迟迟至是。问来人，则前方恐过峻，减去芒硝故也。乃告其来人曰：归语张某，不服芒硝，勿望余治也。来人归以实告，张勉强加芒硝服之，越半时腹中如坠，暴下如血块数次，病者气乏而卧，痢亦止矣。越日遣人又问，告曰：病已去，不必再下，但病实伤阴，以芍药汤和之，数剂则无误矣。归遂服芍药汤，半月而安。中秋备物作谢，言之始知其详。
痰热上潮喉中结核数年不孕
越二年，张七兄之女，适吾乡大郎神村宋，数年不孕，月事不以时至，饮食亦少。春间忽患咽痛，人以为感冒瘟疫，凡解毒散风、销火凉血诸药，无所不施，而喉痛如故。张求余治，诊其脉沉而滑，恐喉中肿烂，以箸按其舌而视之，则痰核累累如贯珠。白喉连及上腭，且复如此。乃笑曰，如此不着紧病，乃累赘至是乎。头不痛，鼻不塞，非感冒也；项不肿，喉不闭，非瘟疫也，不渴不热，非火也；不汗不昏，非风也。此乃痰热上潮，结而成疮形，按之软而滑，其痛若口疮。况病者体素肥，痰膜凝结，故数年不孕，月事不至。但去其痰，则血络通，不惟止喉痛，即月事亦当至也。其父喜，急索方，余以芩连二陈汤示之，告曰，二服喉痛自止，再合加味二陈丸一料，时常服之，不半年必更壮矣。病者听之，余亦不问．迨戊午春，于宗人处，见张至，急揖谢曰，小女病，诚如君言，今抱子矣，鄙亲家亦极感谢。为之一笑。
[Background Information]
Book: Zuihua Chuang Yi An (Medical Cases from the Drunken Flower Window)
Chapter: Main Text (5/9)
Category: Medical Discussion
The wife of Niu, a resident in the village, was constitutionally robust but suddenly suffered from amenorrhea. Initially, it was thought to be pregnancy. As time passed and abdominal pain developed, it was re-diagnosed as deficiency, and tonifying treatments were administered, which only exacerbated the condition. The illness dragged on for several months, resulting in a distended abdomen like a drum and loss of appetite. I was invited to treat her. Her pulse was hard and forceless at both Guan positions (middle position). I asked if she felt thirsty; she replied that she was very thirsty in the first half of the day and only slightly so in the second half. I stated, "This is Stomach Heat combined with Blood Stasis." Typically, patients with Stomach Heat experience burning sensations in the chest and diaphragm upon onset, and may develop coughs with thick sputum when severe. The patient confirmed this. I first prescribed Sanhuang Siwu Tang (Three-Yellow Four-Substance Decoction) to break up the stasis. After two doses, more than ten dark purple blood clots were discharged, and the abdominal distension subsided slightly. Subsequently, Liangdi Dihuang Tang (Two-Earth Rehmannia Decoction) was used with added Gardenia (Gardeniae Fructus), Forsythia (Forsythiae Fructus), and Akebia stem (Akebiae Caulis), administered continuously. Over a month later, menstruation resumed, though the cycle remained irregular. She was instructed to regularly take Guishao Dihuang Tang (Angelica and Peony Rehmannia Decoction). Several months later, her menses returned on schedule, and she eventually conceived.
Phlegm-Fire Obstructing the Lung
The daughter of my neighbor, Mr. Guo, had remarried into a neighboring village and rarely returned home for visits. One day, she suddenly developed a cough. Initially disregarded, it worsened over time. When consulted, other physicians diagnosed it as Consumption Deficiency (Xu Lao). Treatments began with Qi tonification, then moved to blood-invigorating methods, and later to Spleen-regulating and Liver-soothing strategies. Despite frequent changes in prescription, the illness persisted. One day, her mother brought her to me for treatment. I asked, "Is your cough intermittent, or does it come with facial flushing, rapid breathing, and continuous sound?" She replied that the breathing difficulty was severe. Observing her ruddy complexion, I determined it was not a deficiency pattern. Her pulse was floating, slippery, and rapid at the Right Cun position (lung position), while other positions were normal. I told her, "This is Phlegm-Fire obstructing the Lung Meridian. You likely suffer from chest fullness and oppression. Upon onset, phlegm and cough appear together. This is not Consumption Deficiency, but rather an Excess-Heat syndrome." I prescribed Qinlian Erchen Wan (Scutellaria and Coptis Pinellia Citrus Pill) with added Mulberry Bark (Mori Cortex) and Thunberg Fritillary Vine Stem (Thunbergii Caulis) to unblock the Lung Qi. After three days, the cough improved. Upon follow-up, the rapid pulse had decreased, but the slippery pulse remained. I said, "The heat has subsided, but the phlegm remains. If not removed, it will likely recur." Therefore, I used Pingchen Tang with Zhi Shi (Immature Bitter Orange) and Da Huang (Rhubarb Rhizome) to purge. After two doses, several bowls of stubborn phlegm were expelled, the chest felt instantly open, and the cough ceased.
Wind-Phlegm Causing Cough
Cough can be caused by Wind-Cold, Summer-Heat, Heat, dietary stagnation, worry, and fatigue. *Yi Zong Bi Du* elaborates extensively on this symptom based on the *Neijing*, and students should study it carefully. Treating all cases uniformly inevitably leads to errors.
Mr. Hao Xiushan, a fellow townsman who worked as a silver merchant in the capital, had been coughing since autumn until November, without relief from multiple physicians. I was residing in Xiangling at the time and did not know him. One day, Mr. Liang brought him to seek my treatment. When asked about his ailment, he replied that he had been coughing for four months. Upon asking if he had received treatment, he answered that he had taken hundreds of prescriptions with no improvement. He then pulled out a bundle of prescriptions from his robe. Examining them closely, they consisted mainly of Ginseng (Ginseng Radix et Rhizoma), Poria (Poria), Astragalus (Astragali Radix), and Atractylodes (Atractylodis Macrocephalae Rhizoma). Likely due to his weak constitution and wealth, vulgar doctors had treated him for deficiency. His pulse was normal except for the Lung position, which was floating and slippery. I explained, "Floating indicates Wind, and slippery indicates Phlegm. You have accumulated phlegm and contracted Wind. Wind and Phlegm battling each other causes the cough. If we use Ginseng and Astragalus to secure the Couli (pores and interstices) without opening them, the Wind will have no exit, and the cough will never cease." I prescribed a few herbs to resolve the issue. Mr. Hao, pleased with my straightforward approach, mentioned that he had a history of hemoptysis in his youth and feared harsh purgative or draining medicines. I advised, "That is why other doctors used Ginseng and Astragalus. However, youthful hemoptysis is not necessarily deficiency. Even if it were, the bleeding has stopped, and now the cough persists. Are you asking me to treat the cough or the bleeding?" He laughed and agreed. I prescribed Xingsu Yin (Almond and Perilla Decoction) with Hawthorn (Crataegi Fructus) and Immature Bitter Orange (Aurantii Immaturus). I instructed, "Five doses will cure you; there is no need to return." He left with the prescription. Five days later, he sent a note inviting me to watch opera, followed by a lavish banquet. At that time, I was preparing to travel to Shaanxi, so I arranged for his associates to accompany him to open a bank there, allowing us to maintain our friendship.
Illness Caused by Depression: Legs and Eyes Gradually Wasting Away
Li Lianfang, a Shengyuan (licentiate), studied with me in his youth. Later, after failing the童军 (Tongjun) exams repeatedly, he went into business in Chu. Upon returning unemployed, he again pursued official careers and entered the county school. Lianfang lost his parents young, married three times but remained widowed, and had no heirs. In the Bingchen year, when I returned from Beijing, he was already impoverished. Due to depression, his legs gradually became useless, and his eyesight dimmed. However, he could still walk and write. Pitying his poverty, I took him to Shaanxi to manage our guesthouse affairs. Later, I returned home for my father's mourning. Concerned for Lianfang's lack of support, I recommended him as a secretary to Feng Zi'an, the Assistant Magistrate of Zhaoyi. Feng was also a fellow townsman and held a minor post. Although not outstanding, Lianfang was careful and meticulous, keeping accounts orderly, and getting along well with his employer. Privately, however, Lianfang felt desolate being over fifty with no family, deepening his depression. By the following autumn, he returned alone. I assumed he had fallen out with his employer and visited him urgently. His eyes had developed external nebulae (cataracts/opacities), and his legs were heavy and immobile. Feng had resigned due to poor revenue, forcing Lianfang's return. He requested treatment for his eyes and legs. His Heart and Liver pulses were wiry and urgent, and the Chi positions (kidney position) were faint. Unable to speak plainly in haste, I advised him to broaden his mind and comfort himself, noting that the disease would not heal overnight and required months of quiet recuperation. Lianfang listened, but with dwindling finances, he grew more distressed. His blindness and leg immobility worsened.
There was an ophthalmologist from Zhaocheng, a renowned expert. He had introduced himself twice over the past year, claiming to cure even long-standing external eye obstructions via acupuncture. I admired him greatly and urgently requested his consultation for Lianfang. The doctor examined him and said, "The opacity membrane is still tender; it cannot withstand acupuncture yet. Wait a few months until it thickens and turns gray, then it can be flicked away." After the doctor left, he told me, "The pupil is damaged; treatment will be ineffective. Better to let it be. The previous statement was merely an excuse." About half a year later, Lianfang died. I wrote a couplet: "What crime did you commit, to be like Zuo Qiuming blinded or Sun Bin crippled? Heaven's will is unfathomable, causing Qianlou to lose his wife and Bodao to have no son."
Excessive Yin Fire: Clearing and Purging Failed
Some diseases are bizarre and inexplicable; relying solely on formulas often yields no effect. The mother of my clan brother Wang Danwen suddenly developed fever in mid-spring, accompanied by thirst, confusion, dizziness, sweating, intense heat resembling fire, and near-madness. Her nephew, a medical practitioner, diagnosed it as Heat, specifically Yangming Zhengbing (Yangming Channel Disease). He administered Baihu Tang (White Tiger Decoction) with one tael of Gypsum (Gypsum Fibrosum), but the heat persisted. Another neighbor, Scholar Li, also a physician, used Chengqi Tang to purge, resulting in slight bowel movement, yet the heat remained. Danwen invited me to examine her. Her pulse was extremely deep and rapid. I identified excessive Yin Fire (hyperactive ministerial fire) and severe intestinal dryness. I told Danwen, "There is no solid accumulation internally; the fire harasses the Heart. Purging is inappropriate; clearing and descending is needed." I urgently prescribed Dihuang Tang (Rehmannia Decoction) with Gardenia (Gardeniae Fructus) and Sanhuang (Three Yellows: Scutellaria, Coptis, Rhubarb). After taking the medicine, her heart felt clearer, but the heat persisted. That night, it snowed heavily. At dawn, the patient desired to eat snow. Danwen, citing her age, refused. Later, when Danwen stepped out, the patient crawled to the steps, lay down, and ate about three bowls of snow, feeling instant mental clarity. After eating more, she returned to bed. By evening, the heat subsided, and she cooled down. She rose the next day and was fully recovered after three days. Alas! Medicine failed, but heaven sent snow to cure her. Snow is yin-cold and pure, far superior to medicinal clearing and descending. Physicians lack this method and dare not use it.
Wind-Cold Edema Misdiagnosed as Deficiency
The proverb says, "Old doctors, young diviners," which is not necessarily true. Success depends on innate talent and learning. Those with clear minds who read much are excellent even when young; those with turbid minds remain confused even when old. In the spring of Xin You year, my father, though over seventy, was constitutionally strong. Due to New Year social engagements, rich food, and a prior cold, he suffered from lingering phlegm and cough. After the Lantern Festival, swelling appeared suddenly below his mouth, spreading to both feet and then both hands. I wanted to treat him, but he refused medication, believing his health would recover naturally. Three days later, it worsened. Since my eldest daughter-in-law had a minor ailment previously treated by Physician Yang, I asked Yang to treat my father under the guise of treating her. Yang arrived, elderly, wearing glasses, leaning on a cane, arrogant and dismissive. After tea, I asked about my father's illness. Yang palpated the pulse for over an hour and said, "Elderly Qi deficiency causes this. Tonify deficiency first; do not treat the edema. If Qi is sufficient, the swelling will resolve." I found his reasoning chaotic and countered, "The Classics state: 'Edema begins with puffiness under the eyes like a sleeping silkworm.' My father fits this description. We should guide water out first." Yang angrily replied, "Treating strictly by books is absurd. Take my medicine, and you will see its efficacy." I did not openly disagree but requested the prescription. It was Bazhen Tang (Eight-Treasure Decoction) plus Cinnamon Twig (Cinnamomi Ramulus) and Aconite (Aconiti Lateralis Radix Praeparata), with five fen of Tangerine Peel (Citri Reticulatae Pericarpium) and three fen of Thunberg Fritillary Vine Stem. He claimed it would promote urination and left. Knowing it would fail, but respecting my father's trust in his age, I waited. The medicine increased chest and abdominal fullness and worsened the swelling. Desperately, I secretly prepared Xingsu Yin with Thunberg Fritillary Vine Stem, Achyranthes Root (Achyranthis Bidentatae Radix), and Stephania Root (Stephaniae Tetrandrae Radix), three qian each, and gave it to my father. By midnight, he urinated five or six times. By morning, his abdomen was loose, the swollen areas wrinkled, and the cough subsided. Seeing the effect, he took four more doses. The swelling disappeared, except for the scrotum. After three days, I added Semen Lepidii (Lepidii Semina) and Black and White Morning Glory Seeds (Pharbitidis Semina) to the formula. One dose resulted in profuse urination (over ten bowls), the scrotum normalized, and the disease vanished. The proverb values old doctors for their experience, but someone like Yang, despite longevity, could never dream of such skill.
Yang Deficiency and Blood Heat Misdiagnosed as Sha (Sha Disease)
In our village, it is common to say "Cold Damage or Heat Disease" when seeing a sick person, and "Han Syndrome" when a doctor arrives. Few realize Cold Damage and Heat Disease are opposites. Cold Damage involves genuine Cold invasion requiring warm dispersal, as per Zhang Zhongjing's methods. Heat Disease arises from external Wind-Cold-Summer-Heat or internal dietary/lust excesses. Negligence here can kill quickly. For Spring Warmth and Summer Heat, Liu Hejian's methods are best. For dietary/lust issues, combining Li Dongyuan and Zhu Danxi's methods is comprehensive.
My eldest daughter-in-law fell ill with Warm Disease ten days after marriage, groaning and restless. Her father summoned a local physician, a Bingwu Shengyuan known for being frivolous and poorly regarded. Though knowledgeable, he used few herbs (3-4 flavors) measured in fen, achieving little success. He diagnosed my daughter-in-law with Sha Disease and prescribed Xijiao Jiedu Tang (Rhino Horn Detoxification Decoction). Taken hastily, the Sha did not appear, and the heat remained. Another physician, a peddler from Wu'an, Henan, with basic knowledge and frequent prescription errors but occasional successes, was summoned. He diagnosed Sha Disease complicated by Stomach Cold, prescribing Pingwei San (Pingwei Powder). I opposed it, but family members insisted on trying it due to past coincidental successes. Upon ingestion, the heat intensified to madness-like states, causing sleepless nights. I examined her: pulse extremely deep and rapid, symptoms critical. I told her father, "In my opinion, this is Yin Deficiency with Blood Heat. It is a Heat syndrome, not Sha. If it were Sha, after ten days, some eruption would be visible. As my brother's daughter-in-law, I will treat her privately; if mistaken, my relatives will understand." He agreed. I prescribed a large dose of Dihuang Tang replacing Sheng Di Huang (Rehmanniae Radix) with Dihuang Tang, combined with Sanhuang Tang (Three-Yellow Decoction). She slept deeply by the second watch. To clear residual heat, I added Cicada Slough (Cicadae Perioaterium) and Lampwick (Ziziphus Spinosae Semen Endospermium). After four doses, the heat stopped, and she stabilized. She was instructed to take Maiwei Dihuang Wan (Lily and Schisandra Rehmannia Pill) daily, recovering completely in half a month.
Yin Heat Macules
My nephew, Yingchang, traveled for business and neglected diet. In April, he suddenly developed macules (rash/spots). Initially unclear, Doctor Dong treated it as a seasonal condition with food stagnation using Wuji San (Five Accumulations Powder), worsening the condition. His body turned red like erysipelas, and his eyes became red. An old female massage therapist diagnosed the macules, pricked his tongue and genitals, and sucked the area. His mind cleared slightly, and breath steadied, but the heat persisted. I visited and saw profuse sweating, cracked lips, and assumed Yangming Stomach Heat. His pulse was deep and rapid. Urine was red; stool normal. Abdomen soft. I determined it was Yin Heat, unsuitable for purging, requiring clearing. I prescribed Zhibai Dihuang Tang (Anemarrhena, Phellodendron, and Rehmannia Decoction). Heat reduced after one dose and cleared after three. He lay exhausted, yellow and thin, craving food. I told him the disease was gone, no more medicine needed, just light diet and rest. He recovered after a month of care. This was also a Yin Heat syndrome.
Blood Deficiency and Liver Qi Stagnation
Wang Danwen's mother contracted an epidemic in summer, lingering for months. After changing physicians, the illness faded, but she suffered fever, headache, chest irritability, and mood swings, refusing medication despite persuasion. One day, severe headache prompted Danwen to bring her to me. Her pulse was deep and rapid, with a choppy Liver position and faint Left Cun. I diagnosed Blood Deficiency and Liver Qi Stagnation. I prescribed Guishao Dihuang Tang (Angelica and Peony Rehmannia Decoction) with Mint (Menthae Haplocalycis Herba) and Gardenia to clear heat, explaining that nourishing Blood would soothe the Liver ("Yi and Gui share the same source") and stop the headache. Two days later, she reported cooling and cessation of headache. She refused further medication, and I allowed it as the condition seemed stable.
Discussion on Ginseng
I read Ji Wenda's notes debating Ginseng. He stated that Guandong Ginseng absorbs Eastern generating Qi, favoring lifting and tonifying; Shangdang Ginseng absorbs Central Earth Qi, favoring Spleen cultivation. This view was novel. Ancient prescriptions referred to Shangdang Lupang Ginseng. Guandong Ginseng likely did not enter China before the Ming Dynasty. During the Ming, Officer Wu traveled to Liaoshen, consumed half a jin of Eastern Ginseng for longevity, and suffered incessant diarrhea, proving Guandong Ginseng entered China only then. Pre-Ming Ginseng was Lupang. Historically, Lupang grew wild and potent; modern cultivation reduces its strength.
Bencao states that large doses of Ginseng promote circulation, while small doses cause stagnation. This is crucial. Herbs act by Qi; Ginseng is sweet and warm, promoting lubrication and purging, hence Wu's diarrhea. Unlike grains benefiting the Spleen/Stomach directly.
I observe modern scholars using Eastern Ginseng daily for maintenance, leading to appetite loss or diarrhea. How deluded they are! Following Wenda's intent, Eastern Ginseng is effective for Qi deficiency with fearfulness or critical smallpox cases where the rash fails to erupt. For Spleen/Stomach weakness with dampness sinking and poor appetite, Lupang Ginseng is specific for strengthening transport. It always works.
I see many modern physicians stocking drugs, using Ginseng and Deer Antler indiscriminately to ensure sales. Their sin is grave. I record this to warn the ignorant and reckless.
Excess Pattern Resembling Deficiency
My fellow townsman Zhang Shouzhi's wife suffered from dysentery, unresponsive to treatment. Invited by relative Liang, I examined her. She was over fifty, emaciated. Pulse floating and rapid. She reported severe fever and thirst. I predicted abdominal distension and pain, which she confirmed. I told Zhang, "Externally appearing deficient, it is actually an Excess pattern requiring purging." Zhang disagreed, arguing her constitution was weak and dysentery increases deficiency, fearing purging would harm her. He suggested mild purgation. I warned that mild purgation was useless and delay might lead to Jin Kou Li (Jin Kou Dysentery, inability to eat/drink). Reluctantly, he asked for a prescription. I prescribed Dachengqi Tang (Major Order the Qi Decoction). Days later, he asked why progress was slow. I learned he had omitted Mangxiao (Mirabilite) fearing harshness. I instructed him to tell Zhang: "Without Mirabilite, do not expect my treatment." Zhang reluctantly added Mirabilite. Half an hour later, he experienced abdominal heaviness and passed bloody clots several times. The patient lay exhausted, and dysentery stopped. The next day, I advised stopping purgation but using Shaoyao Tang (Peony Decoction) to harmonize, as the excess had injured Yin. He took Shaoyao Tang for several doses and recovered in half a month. Mid-Autumn Festival, he thanked me, revealing the details.
Phlegm-Heat Rising: Throat Tubercles and Infertility for Years
Two years later, Zhang's daughter married Song from Dalangshen Village. She had been infertile for years, with irregular menses and poor appetite. In spring, she developed sore throat. Treated as cold/epidemic with detoxifying, wind-dispersing, fire-reducing, and blood-cooling herbs, the pain persisted. I examined her: pulse deep and slippery. Pressing her tongue revealed bead-like phlegm nodules. White throat membranes extended to the palate. I laughed, "Such a trivial burden!" Headache, nasal congestion, neck swelling, throat closure, thirst, fever, sweating, or coma were absent, ruling out cold, epidemic, fire, or wind. This was Phlegm-Heat rising, forming ulcer-like lesions. Soft and slippery upon touch, painful like mouth ulcers. Her obesity indicated condensed phlegm membranes, causing infertility and amenorrhea. Removing phlegm would open blood collaterals, stopping throat pain and restoring menses. Her father eagerly sought the prescription. I prescribed Qinlian Erchen Tang (Scutellaria, Coptis, Pinellia, and Citrus Decoction). Two doses stopped throat pain. I advised continuing Jiawei Erchen Wan (Modified Pinellia and Citrus Pills). Within half a year, she regained strength. In Wuwu spring, I saw Zhang, who bowed gratefully, reporting his daughter had borne a child. His in-laws were also thankful. We smiled.
Spleen Deficiency with Uterine Bleeding