山阴沈某年四十许。偶一烦劳。则痫病即发。神不自主。谵言妄语。不省人事。或语鬼状。诊之两寸空大无伦。两
关弦紧。舌中心陷有裂纹。余谓病属虚症。神不守舍。神虚则惊。非有鬼祟。神气浮越。故妄见妄言。用桂枝龙牡汤加
龙眼肉膏。嘱其守服三十剂。服二十剂。而病已不复发矣。按此症与前陈姓案。乃一虚一实之对症。总须审症的
确。指下分明。庶所投辄效。病症万端。治不执一。要不外乎虚实寒热四字。桂枝龙牡汤。有旋转乾坤之妙用。非熟
读金匮者不知也。
定庠生金彩眉。其夫人丙戌秋病霍乱卒。渠亦患湿热症。是年定海之霍乱。经余治愈者甚多。及彩眉之遇余也。
则在仲冬时矣。盖渠自秋间患湿温之后。失于清解。留邪在络。且丧偶悲郁。再有烟癖。耗伤精血。烦躁不寐。目不
交睫者匝月。日间坐卧不安。百感交集。欲食而不能食。欲卧而不能卧。饮食或宜或不宜。神识似痴。脉之空大。指
下极乱。余曰。此正金匮所云百合病也。再兼痰上冲。遂与百合地黄汤。加清痰降火之药。两剂稍能寐。而神志仍
似痴呆。乃专清其痰火。而加宁神定志之品。出入加减。至丁亥春始痊。
赵忠翁。年近八旬。前任镇海教谕。常患头风。发则日夜无度。左颊上额及巅。经络不时抽掣。自觉如放烟火冲状。
通夜不能寐。脉虚滑流利。有时弦劲而大。余谓风阳上扰。阳明少阳之火挟痰而逆冲于上。额旁及耳前后两颊。
现青络甚多。法当尽刺出血。灵枢云。诸络现者尽泻之。乃刺两颊及眉心出血。复针颊车、地仓、承浆、率谷、百合、
迎香等穴。行六阴数。凡针四次。筋不抽掣矣。方用僵蚕、桑叶、麦冬、山栀、石斛、丹皮、竹茹、青黛、丝瓜络、牡
蛎、阿胶等品。养血和络。调理数剂而安。次年立春后复发。但不如前之甚也。时值六出纷飞。不能用针。改用推法。
以指代针。推后痛稍缓。雪消天霁。复针率谷、风府。方药如前法。服数剂而又愈。以后每少发。投前方辄效。徐洄溪
云。凡经络之病。不用针而徒用药。多不见效。其信然矣。
山阴县的沈先生，年龄四十岁左右。偶尔因为过度劳累，癫痫就会发作。精神无法自主控制，胡言乱语，不省人事。有时说话像有鬼附身一样。诊脉时，两手寸脉空大无比，关脉弦紧。舌中心凹陷且有裂纹。我认为此病属于虚证，神气不能守舍。神气虚弱则易惊悸，并非真的有鬼祟作怪。这是因为神气浮越，所以出现幻觉和妄言。使用桂枝加龙骨牡蛎汤（Guizhi Longgu Muli Tang, Cinnamon Twig Decoction with Dragon Bone and Oyster Shell）加入龙眼肉膏。嘱咐他坚持服用三十剂。服用了二十剂后，病情就不再复发了。按语：这个病例与前一个陈姓患者的案例，是一个虚证和一个实证的对症治疗。关键在于必须仔细辨证，确保诊断准确，脉象清晰明了，这样下药才能立即见效。病症千变万化，治疗方法不能拘泥于一种，但总离不开“虚、实、寒、热”这四个字。桂枝加龙骨牡蛎汤具有扭转乾坤的奇妙功效，不熟悉《金匮要略》的人是不知道这一点的。
定海县的生员金彩眉，他的夫人在丙戌年秋天因霍乱突然去世。他也患上了湿热证。那年定海发生的霍乱，经我治愈的患者很多。等到金彩眉来找我看病时，已经是仲冬时节了。大概是因为他在秋季患了湿温病之后，未能及时清热解表，导致邪气滞留于络脉。加上丧偶后的悲伤抑郁，以及有吸烟的习惯，耗伤了精血。他烦躁不安，失眠，整整一个月眼睛都不曾闭合。白天坐卧不宁，各种感触交织在一起。想吃东西却吃不下，想睡觉却睡不着。饮食有时合适有时不合适。神识恍惚像痴呆一样。诊脉时脉象空大，指下感觉极其紊乱。我说：这正是《金匮要略》中所说的百合病（Baihe Bing, Lily Disease）。再加上痰浊上冲。于是给予百合地黄汤（Baihe Dihuang Tang, Lily and Rehmannia Decoction），加入清热化痰降火的药物。服用两剂后稍微能入睡，但神志仍然像痴呆一样。于是专门清除痰火，并加入宁心安神定志的药物。方药出入加减，直到丁亥年春季才痊愈。
赵忠老翁，年龄接近八十岁。曾任镇海县教谕。经常患有头风（Head Wind/Chronic Headache），发作起来不分日夜。左侧脸颊、额头及头顶的经络不时发生抽搐。自觉感觉像有烟火向上冲撞。整夜无法入睡。脉象虚滑流利，有时弦劲而大。我认为这是风阳上扰，阳明经和少阳经的火邪挟带痰浊逆冲于上。额头旁边及耳朵前后、两侧脸颊，现出许多青色络脉。治法应当将这些显露的络脉全部刺破出血。《灵枢》说：凡是显露的络脉都要泻之。于是刺破双侧脸颊及眉心出血。又针刺颊车（Jiache, ST6）、地仓（Dicang, ST4）、承浆（Chengjiang, CV24）、率谷（Shuai Gu, GB8）、百合（注：此处疑为笔误或特定经验穴，非标准穴位，通常无此名，结合语境可能指局部阿是穴或笔误，但在翻译中保留原意或忽略，鉴于要求提取实体，若为标准穴则提取，此处暂按原文处理，若为错误则不列入标准穴位列表，但为了忠实原文，在翻译中保留）、迎香（Yingxiang, LI20）等穴位。施行六阴数手法。总共针刺四次，抽搐停止了。方药使用僵蚕、桑叶、麦冬、山栀、石斛、丹皮、竹茹、青黛、丝瓜络、牡蛎、阿胶等药材。养血和络。调理几剂后就安稳了。次年立春后复发，但不比以前严重。当时正值大雪纷飞，不能用针。改用推拿推法。以手指代替针具。推拿后疼痛稍缓解。雪消天晴后，再次针刺率谷、风府（Fengfu, GV16）。方药使用方法如前。服用几剂后又痊愈了。此后很少再发作，投用前方往往有效。徐洄溪（Xu Hui Xi, Xu Dachun）说：凡是经络的疾病，如果不使用针灸而仅仅用药，大多不见效。这话确实可信啊。
Mr. Shen from Shanyin, aged about forty. Occasionally, due to overexertion, his epilepsy would manifest. His spirit was not under his own control; he spoke deliriously and nonsensically, losing consciousness. Sometimes his speech resembled that of someone possessed by spirits. Upon pulse diagnosis, the Cun (Inch) pulses on both wrists were excessively empty and large, while the Guan (Bar) pulses were wiry and tight. The center of his tongue was depressed with cracks. I stated that this disease belongs to deficiency patterns, where the Spirit does not reside in its proper abode. When the Spirit is deficient, it leads to fright; this is not caused by actual malevolent spirits. Rather, it is because the Spirit-Qi is floating and overflowing, thus causing hallucinations and delirious speech. I prescribed Guizhi Longgu Muli Tang (Cinnamon Twig Decoction with Dragon Bone and Oyster Shell) supplemented with Longyan Rou Gao (Longan Fruit Paste). I advised him to take it continuously for thirty doses. After taking twenty doses, the disease did not recur. Note: This case and the previous case of Mr. Chen represent a contrast between deficiency and excess patterns requiring corresponding treatments. The key lies in accurate syndrome differentiation and clear pulse identification, so that the administered treatment yields immediate results. Diseases are myriad, and treatments should not be rigid; however, they ultimately revolve around the four characters: Deficiency, Excess, Cold, and Heat. Guizhi Longgu Muli Tang possesses miraculous efficacy in restoring balance, a knowledge unknown to those who have not thoroughly studied the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet).
Jin Cai mei, a Xiucai (degree holder) from Dinghai, lost his wife suddenly to Cholera (Huo Luan) in the autumn of the Bingxu year. He subsequently suffered from Damp-Heat Syndrome. That year, many cases of Cholera in Dinghai were cured by me. When Jin Cai mei sought my treatment, it was already mid-winter. It seems that after suffering from Warm-Dampness (Wen Wen) in the autumn, he failed to receive timely clearing and resolving treatment, leaving pathogenic factors lingering in the collaterals. Furthermore, the grief and depression from losing his spouse, combined with a smoking habit, consumed his Essence and Blood. He experienced irritability and insomnia, keeping his eyes open for a whole month without sleep. During the day, he was restless sitting or lying down, overwhelmed by mixed emotions. He desired to eat but could not, desired to lie down but could not. His diet was sometimes suitable and sometimes not. His mental state seemed dull like dementia. The pulse was empty and large, feeling extremely chaotic under the fingers. I said: This is exactly what the *Jingui Yaolue* refers to as Baihe Bing (Lily Disease). Additionally, there was Phlegm rushing upward. Therefore, I prescribed Baihe Dihuang Tang (Lily and Rehmannia Decoction) with added herbs to clear Phlegm and descend Fire. After two doses, he could sleep slightly, but his mental state remained dull. Thus, I focused solely on clearing Phlegm-Fire and added herbs to calm the Spirit and stabilize the Will. Through modifications of the formula, he recovered by the spring of the Dinghai year.
Old Man Zhao Zhong, nearly eighty years old, formerly served as the Director of Education in Zhenhai County. He frequently suffered from Tou Feng (Head Wind/Chronic Headache). Upon onset, it lasted day and night without cessation. The meridians on the left cheek, forehead, and vertex twitched intermittently. He felt as if fire and smoke were rushing upward. He could not sleep all night. The pulse was deficient, slippery, and fluent, sometimes wiry, forceful, and large. I reasoned that Wind-Yang was disturbing upwards, with Fire from the Yangming and Shaoyang meridians carrying Phlegm to rush counter-currently upward. Many blue collaterals were visible on the sides of the forehead, around the ears, and on both cheeks. The method should be to puncture and bleed all visible collaterals. The *Ling Shu* states: "All visible collaterals should be drained." Thus, I punctured the bilateral cheeks and the glabella to release blood. I also needled Jiache (ST6), Dicang (ST4), Chengjiang (CV24), Shuaigu (GB8), Yingxiang (LI20), and other acupoints. I applied the Six Yin counting technique. After four acupuncture sessions, the muscle twitching ceased. The prescription included Cang Er Zi (Stiff Silkworm), Sang Ye (Mulberry Leaf), Mai Dong (Ophiopogon Root), Shan Zhi (Gardenia Fruit), Shi Hu (Dendrobium Stem), Dan Pi (Moutan Cortex), Zhu Ru (Bamboo Shavings), Qing Dai (Indigo Naturalis), Si Gua Luo (Luffa Loop), Mu Li (Oyster Shell), and E Jiao (Donkey-Hide Gelatin). These herbs nourish Blood and harmonize the collaterals. After several doses of regulation, he stabilized. The condition recurred after the Start of Spring the following year, but less severely than before. At that time, heavy snow fell, making acupuncture impossible. I switched to Tuina pushing techniques, using fingers instead of needles. After pushing, the pain eased slightly. Once the snow melted and the sky cleared, I re-needled Shuaigu (GB8) and Fengfu (GV16). The herbal prescription followed the previous method. After several doses, he recovered again. Thereafter, attacks became infrequent, and the previous formula proved effective. Xu Huixi (Xu Dachun) stated: "For diseases of the meridians, relying solely on herbs without acupuncture often yields no effect." This is indeed true.