李青原伤寒治效李青原兄，病伤寒头痛，项强背板，一身尽痛，甚恶寒而不甚发热，自服发散药无汗。予诊之，见其脉浮而弦，甚知其素来阴虚，不能作汗，以九味羌活汤去生地、黄芩，加当归八钱，一服得透汗而解。方本景岳归柴饮，景岳专用柴胡，只治少阳症，不能治太阳症，特变而通之。陶节庵九味羌活汤治江南伤寒最好，江南无正伤寒，不能用麻黄汤也。或议其黄芩、生地，不应见而用凉，然已见口渴欲饮，用之有效，否则不妨易之。予自治李青原后，每遇伤寒夹阴虚者，即以节庵景岳法参用，去芩、地，加当归，少则五钱，多至一两，无不得汗而解，三载以来取效不下数十人。然则斯法亦殆可传也。
凡发散药，太阳经居多，阳明经则白芷、葛根、升麻三味，少阳经则柴胡一味。仲景小柴胡汤为少阳症而设也。疟症不离乎少阳，今人用小柴胡汤治疟症，未尝不可，乃景岳五柴胡饮及正柴胡饮，皆用柴胡，太阳伤寒恐不能散邪而反引入少阳也。至叶天士治疟症，则又戒用柴胡，更不可解。今吴人患疟不敢少用柴胡，以致缠绵日久，甚有死者，皆其遗祸也。景岳名家，叶氏亦医中翘楚，一则重柴胡如此，一则弃柴胡如彼，岂非偏之为害哉。
郭秉和戒烟治效郭秉和嗜鸦片烟，其瘾甚大，忽诣予求戒。予思烟瘾甚怪，书称诸怪病皆属于痰，痰病求之不得则属于虫，五脏之中，为虫所据，则精神血气皆不能自主，而听虫所为，烟瘾之怪虫为之也。诸病从虚而入，诸虫亦从虚而生。五脏之中何脏为虚，则烟毒先入，而虫亦先生，故同此吃烟，而瘾之来也迥不相同，或神疲呵欠，或腹痛异常，或时欲大解，或精泄如溺，种种不一，大抵何脏生虫则现何脏之病，至其时虫欲得烟，其瘾乃至，今欲戒烟，非治虫不可，而欲治虫，非兼补其虚不可。郭兄之瘾来时即屡欲大解，中气肾气皆虚。于是以补中益气合补阴益气，每日作大剂与服，另治药末，用贯众、雷丸、芜夷、鹤虱、苦楝、锡灰、槟榔、榧实、粟壳诸多杀虫之药，稍加烟灰为引，沙糖调服，命于瘾初到时仍吃烟一二口，使虫头皆已向上，即将末药调服，虫食而甘之，而不知其杀之也。伊本服烟二十四口，如法服三日即减去一半，又三日仅余于每早四口，粪后逐日下碎黑虫，细小而多。十数日早上四口总不能免，复请予商酌，予曰：既如此有效，有何酌改，想虫根未尽耳，子姑待之。又十余日，伊忽欣然来告曰：我早上四口烟亦戒矣。问何故?曰：余昨大解后似有物堵塞肛门，极力努挣，突出而下，视之如一小胞衣，破之则皆碎虫也。一时传闻皆以为奇，后有瘾小者，以所余末药如法眼之，连治二人，此数年前事也。近日吃烟者更多，求戒者绝少，即郭秉和亦仍吃烟矣。嗟乎!我欲活人，而人皆求死，奈之何哉!此嘉庆二十年前事，邪片烟初本二三换，后忽贵至十换，郭姓本不甚有余，竟吃不起，所以求戒；后烟渐贱，所以复吃。三十五六年来烟贱至半换，吃烟者十有三四，到处烟馆，虽卖菜佣挑浆老亦多吃烟，下至乞丐辈亦吃烟，即穷且病，甚至于死，而皆不悔哀哉。
徽州余姓治效予三十岁时馆于京口，旗营呼协领家呼公六旬外忽得类中症，眩晕非常，头不能抬，夜不能卧，面色浮红。适万廉山先生宰丹徒，荐其乡亲唐朗山先生诊治，朗山以为虚阳上浮，以真武汤坐镇北方，用附子至三钱，合家疑惧，不敢服。朗山力主之，惟予赞之，一服而定，调理煎方百余帖，总用附子五钱，丸药亦重用附子，统计服附子十余片，精神加旺，后不服药，寿至七十七岁。江西宜服附子而能用之于江南郎山先生，真大手笔也。一时称奇，予亦心服，常相往来，多蒙指教，其学问深厚，脉理尤精，并非孟浪用药者。十余年后，李进之兄油行徽伙余姓行二年三十岁，六月出门讨账，抱恙而回。医者以为受暑，投以清凉，忽变周身寒冷，热饮嫌凉。诊其脉沉细若无，知其体本阳微，虽当夏令仍属感凉，以桂附理中汤用附子一钱，如弗服也加至二钱，如弗服也加至三钱，身寒稍减而热饮仍凉，直加至五钱乃日见有效，计服附子二斤许，症乃全愈。盖其家婺源皆服山涧之水，其性极寒，生斯地者体多偏寒，以寒体受寒凉服寒药，故一寒至此，医贵审时兼宜度地非易易也。然予之所以敢用重剂者，由先得叩朗山先生之教也。大凡脉沉多寒症，而亦有不尽然矣。嘉庆十八年予往常州，有朱某者小贩卖人也，，忽得奇疾周身畏寒，医投以温剂不应，因投以热剂如桂附之类，而其寒愈甚。爰求予诊，其脉皆沉，按之至骨略见疾数，知其为同气相求症也。以犀角地黄汤与之，朱本贱业，以得予至为幸，见方即服，一服而寒减，三服而全愈。此等症候，身寒脉沉，未有不用热药者。不知其伏热在至深之地，一遇热药相引而入，并人身之卫阳亦随之而入，故外反憎寒也。朱姓幸服热剂不多，尚能挽救，若肆用热药，如郎山之治呼公及予之治余姓，不过数剂，真阴内竭，肝风必动，不可治矣。孰谓切脉之可忽哉。
李楚生眼病治效李楚生三兄患目，二目皆病，左目尤甚，红痛异常，瞑不能开，勉强开之，盲无所见，头痛难忍，亦左为甚，尤可怪者，大渴欲饮，每日饮浓茶十大碗。蔡医以白虎汤投之，石膏每剂一两许，愈服愈渴，数剂后浓茶加至三十大碗，饮食不思，神烦不寐，终日终夜饮茶而已，两月有余，困顿已甚，乃延予诊。脉皆弦数而大，而右关数疾之中尤欠和柔，子笑曰：此非白虎汤症也。白虎汤乃伤寒时邪，胃有实热，大渴欲冷饮症所用。今因患目而渴，饮欲热饮，不欲冷饮，乃素嗜浓茶，克伐胃气，胃液干枯，求饮滋润，而其实润之者乃更伤之，故愈饮愈渴。彼石膏辈能治实热，不能治虚热，本草载虚人禁用，恐伐胃气，彼庸庸者不知，以为渴饮则当用石膏，而不知外感内伤有天渊之别，热饮冷饮有毫厘千里之分，率意妄投，不独损人之目，即损人之命不难也。其仲兄乃秀才也，问曰；闻目属肝，何患目而胃病如此?予笑曰：肝开窍于目，夫人而知之；乙癸同源，肝亏则肾亏，亦夫人而知之；不知五脏六腑十二经脉三百六十五络其血气皆禀受于脾土，上贯于目而为明，故脾虚则五脏之精气皆失，所使不能归明于目矣。以脾与胃相表里而为胃行精液，胃主降脾主升，胃降然后脾升，饮食入胃，游溢精气，下输于脾，然后脾气散精而上输于肺也。今胃汁干枯，胃气不降，脾有何精液可升，尚能归明于目哉!况病者肝肾本亏，肾不养肝，肝虚生热，热盛生风，以久虚之胃，木火乘之，故不独燥热难堪，饮不解渴，且胃无和气，直致饮食不思，胃不和则卧不安，故夜不能寐也。至目痛自属肝火，头痛自属肝风，而今欲治之，必先救胃，救胃必先戒茶，然后大养胃阴，并养肝肾。胃喜清和，得滋润而气自能降；木虚枯燥，得涵濡而火自能平；火平则风息，眼无火不病，头无风不疼，如此调治，症虽险无虞也。病者虑茶不能戒，予曰：非戒饮也，特戒茶耳。于是以菊花、桑叶代茶，而先投以养胃阴扶胃气重剂，十日后即不思饮茶。然后兼调肝肾，并或清肺以滋生水之源，或清心以泻肝家之热，千方百计，乃得渐痊。二年后其尊人亦得目病，蔡医以为能治，不必延予，而一目瞽矣。
柏邃庵协领耳患临危治效京口协领柏邃庵，予三十岁时馆子其家，彼此契好，不啻手足，计今三十余年矣。邃庵方正从无淫鸦，奈二十余岁初次进京，未知检点，竟不知于何处旅店蒙其不洁，头生颗粒，有似广疮，急延外科医治，想用捺药，随即痊好，而年余发下疳，外科调治久而不愈。予劝以仙遗粮汤下五宝丹，由渐而愈。邃庵最畏服药，愈后未经清理，后乃发为阴癣，腰以下腹以上蔓延无隙，其痒异常，然三十二年以来竟无他患。不意于道光十一年忽有教以医癣者，用紫荆皮为末，以白芨磨汁调敷。余闻之，再三劝以勿治，盖疥癣之疾不足忧也。设使治愈，必生他患，奈邃庵竟为所惑，不纳予言。日以二药裱敷下体，自秋徂冬，癣竟全收，不复作痒，欣然得意。十一月望后忽患耳痛，就予诊脉，其时适值云汀宫保忽患吐红，专礼见招，是日诊脉后即束装赴省，余谓儿辈曰：邃庵脉象大为不好，恐有重症，而予适不在家奈何?儿辈唯唯，盖其一切如常，予言似不确也。赴省一月予接家信，据云邃庵病势沉重，有朝不保暮之象，请予速回，或可一诀。余不胜骇然，幸宫保恙已全愈，随即买舟南下，一日达镇，即诣柏府看视，见其耳连项肿，稠脓淋漓，臭不可近，人则一丝两气，盖已米饮不下者九日矣。见余至亦不能多言，惟曰：弟虽来，吾亦不吃药也。询之伊子症势如此，何为不肯服药?据云一月之中所请内外科服药不少，大抵清凉居多，以致胃败，故邃庵誓不服药矣。予因转为邃庵曰：兄之病源，惟予深知，他人不及知也。不知者认为寻常之火毒，必用凉药，须知此症不但不可用凉，且宜用温，兄如服弟药，三剂必然有效，如不效再不服药何如?邃庵闻以温易凉，不觉首肯。予遂以归脾汤加减，另以五宝丹加西牛黄与服，三剂后臭味顿减，口味大开，精神渐振。邃庵问予何药之神也?予笑曰：兄之病根在三十年前，他医不及知，即兄亦念不及此也。兄当年曾沾染恶气，误服捺药，后变为下疳，愈后未经清理，渐化为阴癣，此癣为余气之出路，且周身之湿热皆从此出，原万无治理者也。奈兄误听人言，忽然欲治，居然治愈，而究之风湿热毒从何而去，不觉上攻清窍。又值现与统军不合，告老罢官，虽素阔达，究非得已，Jb怀未免不畅，心寄窍于耳，故病发于耳也。医者不知，肆用寒凉，使热毒欲发不发，遏成臭气，异乎寻常；人之脾胃喜香而恶臭，此等恶臭积于胃中，胃气焉得不败，尚冀饮食之甘乎。且夫治余气之法，以升透为主。尤以扶正为主盖余气即邪气也，正气衰则邪气陷而入内，正气旺则邪气托而达外。常见庸庸者治湿毒之症，专主苦寒攻下，百无一愈，诚昧于医理也。兄之症情节过多，医更难明，动辄得咎，予用归脾汤法可以养心，可以健脾，可以扶胃，可以开郁，可以建中，可以托邪；而又用加味五宝丹诸多宝贵，败毒搜毒，专使外透，不容内蕴，用药得当，似乎通神，虽然现幸获效，仍须癣发，方许收功也。数日后癣渐作痒，十数日后癣遍下体，而耳患全愈，饮食倍常。始终总此一方，并未改易。方余自省回，见邃庵光景亦疑不可救，而竟获速效，此其中殆有天焉，非人力所能致也。
李青原治疗伤寒的疗效：李青原兄，患伤寒头痛，项部僵硬背部板滞，全身疼痛，非常怕冷而发热不明显，自行服用发散药物后无汗。我诊察他的脉象，见其脉浮而弦，深知他素来阴虚，无法出汗，于是用九味羌活汤去掉生地黄、黄芩，加入当归八钱，一服药后透出大汗而病愈。此方本源于张景岳的归柴饮，张景岳专用柴胡，只治疗少阳证，不能治疗太阳证，我特意变通使用。陶节庵的九味羌活汤治疗江南地区的伤寒效果最好，江南没有真正的伤寒（指感受寒邪所致的典型伤寒），不能用麻黄汤。有人议论其中黄芩、生地黄，不应见到热象就用凉药，但如果已经出现口渴想喝水的症状，使用它们是有效的，否则不妨更换掉。我自从治愈李青原之后，每次遇到夹有阴虚的伤寒患者，就参用陶节庵和张景岳的方法，去掉黄芩、生地黄，加入当归，少则五钱，多至一两，没有不透汗而痊愈的，三年来取效不下几十人。那么这种方法大概可以传承吧。
凡是发散药物，大多用于太阳经，阳明经则用白芷、葛根、升麻三味药，少阳经则只用柴胡一味。张仲景的小柴胡汤是为少阳证设立的。疟疾不离乎少阳，现在人们用小柴胡汤治疗疟疾，未尝不可以，但张景岳的五柴胡饮及正柴胡饮，都用柴胡，对于太阳伤寒恐怕不能散邪反而引入少阳。至于叶天士治疗疟疾，又告诫不要用柴胡，更让人难以理解。现在吴地人患疟疾不敢稍用柴胡，导致病情缠绵日久，甚至有死亡的，这都是遗留的祸害。张景岳是名医，叶氏也是医界翘楚，一个如此重视柴胡，一个又那样抛弃柴胡，这难道不是偏执带来的危害吗？
郭秉和戒烟的疗效：郭秉和嗜好鸦片烟，瘾头很大，忽然来找我请求戒烟。我思考烟瘾很奇怪，书上说各种怪病都属于痰，痰病求治不得则属于虫，五脏之中，被虫占据，那么精神血气都不能自主，而听凭虫子所为，烟瘾之怪是由虫造成的。各种病从虚而入，各种虫也从虚而生。五脏之中哪脏虚弱，烟毒就先侵入，而虫也先生出，所以同样吃烟，而瘾来的情况迥然不同，有的神疲呵欠，有的腹痛异常，有的时常想大便，有的精液外泄如尿，种种不一，大抵哪脏生虫就显现哪脏的病，到了时候虫想要得到烟，瘾就来了，现在想戒烟，非治虫不可，而要治虫，非兼补其虚不可。郭兄的瘾来时多次想大便，说明中气和肾气都虚。于是用补中益气汤合补阴益气丸，每天做大剂给他服用，另外制作药末，用贯众、雷丸、芜夷、鹤虱、苦楝、锡灰、槟榔、榧实、粟壳等多种杀虫药，稍加烟灰作为引子，沙糖调服，命令他在瘾初到时仍吃烟一二口，使虫头都向上，随即调服末药，虫吃了觉得甘甜，却不知道是在杀它。他本来每天服烟二十四口，按方法服用三天就减去一半，又三天仅剩每早四口，排便后每日排出碎黑虫，细小而多。十几天早上那四口总不能免，再次请我商量，我说：既然这么有效，有什么可改的？想是虫根未尽罢了，你姑且等待。又过了十多天，他突然高兴来告诉我：我早上那四口烟也戒了。问什么原因？他说：我昨天大便后好像有东西堵塞肛门，极力努挣，突出而下，看它像一小块胞衣，破开全是碎虫。一时传闻都觉得很奇怪，后来瘾小的，用剩下的末药按方法试治，连治两人，这是几年前的事情了。近日吃烟的人更多，求戒的极少，就连郭秉和也又吃烟了。唉！我想救人，而人都求死，能怎么办呢？这是嘉庆二十年前的事情，那时鸦片烟初时二三换银子一斤，后来突然贵至十换银子一斤，郭姓人家本来不太富裕，竟然吃不起，所以求戒；后来烟价渐贱，所以又吃。三十五六年来烟价低至半换银子一斤，吃烟者十有三四，到处是烟馆，即使是卖菜的佣人、挑浆的老翁也多吸烟，下至乞丐辈也吸烟，即使穷困且生病，甚至死亡，都不后悔，悲哀啊。
徽州余姓治疗的疗效：我三十岁时在镇江教书，旗营协领家称呼他为公，六十多岁忽然得了类中风症，眩晕非常严重，头不能抬，晚上不能躺卧，面色浮红。恰逢万廉山先生任丹徒县令，推荐他的乡亲唐朗山先生诊治，朗山认为是虚阳上浮，用真武汤坐镇北方，用附子至三钱，全家怀疑恐惧，不敢服用。朗山力主此法，只有我赞同他，一服药后病定，调理煎方百余帖，总用附子五钱，丸药也重用附子，统计服用附子十余片，精神更加旺盛，后来不服药，寿命至七十七岁。江西适宜服用附子而能用之于江南，朗山先生真是大手笔。一时称奇，我也心服，常相往来，多蒙指教，他学问深厚，脉理尤其精妙，并不是孟浪用药的人。十多年后，李进之兄徽商伙计余姓，行商二年，三十岁，六月出门讨账，抱病而归。医生认为是受暑，投以清凉药，忽然变成周身寒冷，喝热饮还嫌凉。诊其脉沉细若无，知其体质本阳气微弱，虽当夏令仍属感凉，用桂附理中汤用附子一钱，如果不见效加至二钱，如果还不见效加至三钱，身寒稍减但热饮仍觉凉，一直加至五钱才日渐有效，共计服用附子二斤左右，症状才全愈。大概他家婺源都饮用山涧之水，水性极寒，生长在此地的人体质多偏寒，以寒体受寒凉服寒药，所以一寒至此，医生贵在审时度地，并非易事。然而我之所以敢用重剂，是因为先得到了唐朗山先生的教导。大凡脉沉多属寒症，但也有不完全是这样的。嘉庆十八年我往常州，有个朱某是小贩卖人，忽然得奇疾周身畏寒，医生投以温剂不应，因投以热剂如桂附之类，而其寒更甚。于是求我诊脉，其脉皆沉，按之至骨略见疾数，知道他是同气相求症。用犀角地黄汤给他，朱某本是贱业，以为能得到我诊治很幸运，见方即服，一服药而寒减，三服药而全愈。这种症候，身寒脉沉，没有不用热药的。不知道伏热在极深的地方，一遇热药相引而入，连同人身之卫阳也随之内入，所以外面反而憎恶寒冷。朱某幸而服热剂不多，尚能挽救，如果肆用热药，像唐郎山治疗呼公和我治疗余姓那样，不过几剂，真阴内竭，肝风必动，就无法治疗了。谁说切脉可以忽略呢？
李楚生眼病治疗的疗效：李楚生三兄患眼病，双眼都病，左眼尤其严重，红肿疼痛异常，闭目不能睁开，勉强睁开，盲目无所见，头痛难忍，也是左边更甚，尤其奇怪的是，极度口渴想喝水，每天喝浓茶十大碗。蔡医生用白虎汤投治，石膏每剂一两左右，越服越渴，几剂后浓茶加至三十大碗，饮食不思，神烦不寐，终日终夜饮茶而已，两个多月，困顿已甚，于是延请我诊治。脉皆弦数而大，而右关脉数疾之中尤其缺乏和柔，我笑着说：这不是白虎汤证。白虎汤是治疗伤寒时邪，胃有实热，大渴欲冷饮证所用的。现在因为患眼病而渴，想喝热饮，不想喝冷饮，乃是素嗜浓茶，克伐胃气，胃液干枯，求饮滋润，而其实润之者乃更伤之，所以越饮越渴。那些石膏辈能治实热，不能治虚热，本草记载虚人禁用，恐怕伐胃气，那些平庸的医生不知道，以为渴饮则应当用石膏，而不知道外感内伤有天渊之别，热饮冷饮有毫厘千里之分，率意妄投，不仅损害人的眼睛，就是损害人的性命也不难。他的二哥是秀才，问道：听说目属肝，为何患眼病而胃病如此严重？我笑着说：肝开窍于目，是人人都知道的；乙癸同源，肝亏则肾亏，也是人人都知道的；不知道五脏六腑十二经脉三百六十五络的血气都禀受于脾土，上贯于目而为明，所以脾虚则五脏的精气都失，所使不能归明于目了。因为脾与胃相表里而为胃行精液，胃主降脾主升，胃降然后脾升，饮食入胃，游溢精气，下输于脾，然后脾气散精而上输于肺。现在胃汁干枯，胃气不降，脾有什么精液可升，还能归明于目吗？况且病人肝肾本亏，肾不养肝，肝虚生热，热盛生风，以久虚之胃，木火乘之，所以不仅燥热难堪，饮不解渴，而且胃无和气，直致饮食不思，胃不和则卧不安，所以晚上不能睡觉。至于目痛自属肝火，头痛自属肝风，而现在想治疗它们，必须先救胃，救胃必先戒茶，然后大养胃阴，并养肝肾。胃喜清和，得滋润而气自能降；木虚枯燥，得涵濡而火自能平；火平则风息，眼无火不病，头无风不疼，这样调治，症虽险无虞也。病人担心茶不能戒，我说：不是戒饮水，特戒茶而已。于是用菊花、桑叶代茶，而先投以养胃阴扶胃气重剂，十日后即不思饮茶。然后兼调肝肾，并或清肺以滋生水之源，或清心以泻肝家之热，千方百计，才得以渐渐痊愈。两年后他的父亲也得了眼病，蔡医生认为能治，不必延请我，结果一只眼睛瞎了。
柏邃庵协领耳患临危治疗的疗效：京口协领柏邃庵，我三十岁时在他家教书，彼此情好，不啻手足，至今三十多年了。邃庵为人方正，从未沾染淫鸦，无奈二十多岁初次进京，不知检点，竟不知在何处旅店染上污秽，头上生颗粒，有点像广疮，急忙延请外科医治，想用捺药，随即痊好，但一年多后发为下疳，外科调治久而不愈。我劝他用仙遗粮汤下五宝丹，由渐而愈。邃庵最畏服药，愈后未经清理，后来发为阴癣，腰以下腹以上蔓延无隙，其痒异常，然而三十二年以来竟无其他病患。没想到在道光十一年忽然有教他医癣的人，用紫荆皮为末，以白芨磨汁调敷。我听说后，再三劝他不要治，盖疥癣之疾不足忧也。假设治愈，必生他患，无奈邃庵竟被迷惑，不听我的话。每天用这两种药涂抹下体，从秋到冬，癣竟全收，不再作痒，欣然得意。十一月望日后忽然患耳痛，找我诊脉，当时恰逢云汀宫保忽然患吐红，专礼邀请，那天诊脉后即束装赴省，我对儿辈说：邃庵脉象大为不好，恐有重症，而我恰好不在家怎么办？儿辈唯唯，因为他一切如常，我的话似乎不确。赴省一个月我接家信，据说是邃庵病势沉重，有朝不保暮之象，请我速回，或许可以诀别。我不胜骇然，幸好宫保恙已全愈，随即买舟南下，一日到达镇江，即到柏府看视，见其耳连项肿，稠脓淋漓，臭不可近，人则一丝两气，大概已经米饮不下者九日矣。见我到来也不能多言，只说：我虽然来了，我也不吃药了。询问他的儿子症势如此，为何不肯服药？据说是一个月之中所请内外科服药不少，大抵清凉居多，以致胃败，所以邃庵誓不服药了。我于是转为对邃庵说：兄之病源，惟予深知，他人不及知也。不知者认为寻常之火毒，必用凉药，须知此症不但不可用凉，且宜用温，兄如服弟药，三剂必然有效，如不效再不服药何如？邃庵闻以温易凉，不觉首肯。我遂用归脾汤加减，另以五宝丹加西牛黄与服，三剂后臭味顿减，口味大开，精神渐振。邃庵问我什么药这么神奇？我笑着说：兄之病根在三十年前，他医不及知，即兄亦念不及此也。兄当年曾沾染恶气，误服捺药，后变为下疳，愈后未经清理，渐化为阴癣，此癣为余气之出路，且周身之湿热皆从此出，原万无治理者也。奈兄误听人言，忽然欲治，居然治愈，而究之风湿热毒从何而去，不觉上攻清窍。又值现与统军不合，告老罢官，虽素阔达，究非得已，心怀未免不畅，心寄窍于耳，故病发于耳也。医者不知，肆用寒凉，使热毒欲发不发，遏成臭气，异乎寻常；人之脾胃喜香而恶臭，此等恶臭积于胃中，胃气焉得不败，尚冀饮食之甘乎。且夫治余气之法，以升透为主。尤以扶正为主盖余气即邪气也，正气衰则邪气陷而入内，正气旺则邪气托而达外。常见庸庸者治湿毒之症，专主苦寒攻下，百无一愈，诚昧于医理也。兄之症情节过多，医更难明，动辄得咎，我用归脾汤法可以养心，可以健脾，可以扶胃，可以开郁，可以建中，可以托邪；而又用加味五宝丹诸多宝贵，败毒搜毒，专使外透，不容内蕴，用药得当，似乎通神，虽然现幸获效，仍须癣发，方许收功也。数日后癣渐作痒，十数日后癣遍下体，而耳患全愈，饮食倍常。始终总此一方，并未改易。当我从省城回来，见邃庵光景亦疑不可救，而竟获速效，这其中殆有天焉，非人力所能致也。
Li Qingyuan's Efficacy in Treating Shanghan (Cold Damage): Brother Li Qingyuan suffered from headache due to Shanghan, stiffness of the neck and rigidity of the back, pain throughout the body, severe aversion to cold with little fever. After self-administering diaphoretic (sweat-inducing) medicines without sweating, I examined his pulse, finding it floating and wiry. Knowing deeply that he had always suffered from Yin deficiency, which prevented him from sweating, I used Jiuwei Qianghuo Tang (Nine-Ingredient Saussurea Decoction), removing Shengdi Huang (Rehmanniae Radix Preparata) and Huang Qin (Scutellariae Radix), and adding Dang Gui (Angelicae Sinensis Radix) 8 qian. After one dose, profuse sweating occurred and the disease resolved. This formula originated from Zhang Jingyue's Guichai Yin (Return and Bupleurum Drink). Zhang Jingyue exclusively used Chai Hu (Bupleuri Radix), treating only Shaoyang syndrome, not Taiyang syndrome; I specially modified and applied it flexibly. Tao Jian'an's Jiuwei Qianghuo Tang is best for treating Shanghan in Jiangnan. In Jiangnan, there is no "true Shanghan" (typical Cold Damage caused by cold pathogen), so Mahuang Tang (Ephedra Decoction) cannot be used. Some argued against using cooling herbs like Huang Qin and Shengdi Huang when heat signs are not obvious, but if thirst and desire to drink are present, their use is effective; otherwise, they can be replaced. Since curing Li Qingyuan, whenever I encounter Shanghan complicated by Yin deficiency, I combine methods from Tao Jian'an and Zhang Jingyue, removing Huang Qin and Shengdi Huang, adding Dang Gui (5 qian to 1 liang), achieving resolution through sweating in all cases. Over three years, dozens have been cured this way. Thus, this method may be transmitted.
Generally, diaphoretic medicines mostly target the Taiyang Meridian. For the Yangming Meridian, Bai Zhi (Angelicae Dahuricae Radix), Ge Gen (Puerariae Lobatae Radix), and Sheng Ma (Cimicifugae Rhizoma) are used. For the Shaoyang Meridian, only Chai Hu (Bupleuri Radix) is used. Zhang Zhongjing's Xiao Chai Hu Tang (Minor Bupleurum Decoction) is established for Shaoyang syndrome. Malaria (Nüe Zheng) is inseparable from Shaoyang. Using Xiao Chai Hu Tang for malaria is acceptable today. However, Zhang Jingyue's Wu Chai Hu Yin (Five-Bupleurum Drink) and Zheng Chai Hu Yin (True Bupleurum Drink), both containing Chai Hu, might fail to disperse pathogens in Taiyang Shanghan and instead draw them into Shaoyang. Ye Tianshi, conversely, warned against using Chai Hu for malaria, which is hard to understand. People in Wu region now fear using even small amounts of Chai Hu for malaria, leading to prolonged illness and even death, a lingering disaster. Zhang Jingyue was a famous doctor, and Ye was a leader in medicine; one valued Chai Hu so highly, while the other discarded it so completely. Is this not the harm of bias?
Guo Binghe's Efficacy in Quitting Opium: Guo Binghe was addicted to opium, with a strong craving. He suddenly came to me seeking help to quit. I pondered that opium addiction is strange. Books state that strange diseases belong to Phlegm (Tan); if Phlegm diseases cannot be treated, they belong to Parasites (Chong). When parasites occupy the Five Zang Organs, spirit and Qi/Blood lose autonomy, obeying the parasites. The strangeness of opium addiction is caused by parasites. Diseases enter through deficiency; parasites also arise from deficiency. Whichever Zang Organ is deficient receives the opium toxin first, and parasites arise first. Thus, although everyone smokes, the nature of the craving differs greatly: some feel fatigue and yawning, some have abnormal abdominal pain, some frequently need to defecate, some experience seminal emission resembling urination, etc. Generally, whichever Zang Organ hosts parasites shows its corresponding symptoms. When the time comes and the parasite desires opium, the craving arises. To quit, one must treat the parasites; to treat parasites, one must tonify deficiency simultaneously. Guo's cravings involved frequent urges to defecate, indicating deficiency of Middle Qi and Kidney Qi. Therefore, I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) combined with Bu Yin Yi Qi Wan (Tonify Yin and Augment Qi Pill), prepared in large doses daily. Additionally, I made a powder using Guan Zhong (Dryopteris Crassirhizoma), Lei Wan (Vermifuge), Wu Yi (likely a typo or specific local herb, kept as is), He Shi (Helenium Root), Ku Lian (Meliae Cortex), Xi Hui (Tin Ash), Bing Lang (Areca Seed), Fei Shi (Areca Catechu Seed), and Su Ke (Poplar Catkin), many vermifuges, adding a little opium ash as a guide, mixed with rock sugar. I instructed him to smoke one or two puffs when the craving first started, causing the parasites' heads to rise upwards, then take the powder. The parasites would eat it thinking it sweet, unaware it was killing them. He originally smoked 24 puffs daily. Following the method, after three days, the amount halved. After another three days, only four morning puffs remained. Black fragmented worms were passed in stool daily, small and numerous. After ten-plus days, the four morning puffs could not be avoided. He consulted me again. I said, "Since it is effective, what needs changing? The root of the parasites remains. Wait." Ten days later, he happily reported, "I have also quit the four morning puffs." Asked why, he said, "After my bowel movement yesterday, something felt blocked in the anus. Straining hard, it protruded and fell out. It looked like a small placenta. Breaking it open revealed crushed parasites." News spread, considered miraculous. Later, those with weaker addictions tried the remaining powder on two people successfully. This happened years ago. Recently, more people smoke, few seek to quit. Even Guo Binghe resumed smoking. Alas! I wish to save lives, but people seek death. What can be done? This was before the 20th year of Jiaqing. Opium initially cost 2-3 taels per jin, then rose to 10 taels. The Guo family was not wealthy and could no longer afford it, hence seeking to quit. Later, opium prices dropped, so he resumed. For 35-36 years, opium has been cheap (half a tael per jin). 30-40% of people smoke. Opium dens are everywhere. Even vegetable sellers and water carriers smoke. Even beggars smoke. Despite poverty, illness, and even death, none repent. Tragic.
Treatment Efficacy for the Yu Family from Huizhou: At age thirty, I taught in Jingkou (Zhenjiang). A Banner garrison commander, referred to as "Gong," over sixty years old, suddenly suffered from a stroke-like illness (Lei Zhong), with severe vertigo, inability to lift his head, inability to lie down at night, and a flushed face. Mr. Wan Lianshan, magistrate of Dantu, recommended his fellow townsman, Mr. Tang Langshan, for treatment. Langshan diagnosed Floating Deficient Yang rising. He used Zhen Wu Tang (True Warrior Decoction) to anchor the North, using Fu Zi (Aconiti Lateralis Radix Praeparata) up to 3 qian. The family was suspicious and fearful, refusing to take it. Langshan insisted. Only I supported him. One dose stabilized the condition. For over a hundred doses of decoction, Fu Zi was consistently used at 5 qian. Pills also heavily used Fu Zi. Total consumption was over ten slices of Fu Zi. His spirit revived significantly. He lived to 77 without further medication. Jiangxi is suitable for Fu Zi, but using it in Jiangnan required great skill from Mr. Langshan. Everyone marveled, and I was convinced. We interacted often, and he guided me with profound learning and exquisite pulse diagnosis, never prescribing recklessly.
Ten years later, a merchant partner of Brother Li Jinzhi, surnamed Yu, aged thirty, returned ill after traveling in June to collect debts. Doctors attributed it to Summerheat and administered cooling medicines. Suddenly, he became cold all over, finding hot drinks too cool. His pulse was deep and fine, almost imperceptible. Knowing his constitution was inherently Yang-deficient, despite the summer season, he contracted Cold. I used Gui Fu Li Zhong Tang (Cinnamon, Aconite, and Middle-Warming Decoction) with 1 qian of Fu Zi. If ineffective, increased to 2 qian, then 3 qian. Body coldness slightly decreased, but hot drinks still felt cool. Increased to 5 qian, showing gradual effectiveness. Total Fu Zi consumed was about 2 jin. The illness fully resolved. His hometown Wuyuan uses mountain spring water, which is extremely cold. People born there tend to have cold constitutions. A cold constitution exposed to cold and treated with cold drugs led to this extreme coldness. Physicians must consider time and geography, which is not easy. My confidence in heavy dosage stemmed from prior instruction by Mr. Langshan. Generally, deep pulses indicate Cold, but not always.
In the 18th year of Jiaqing, I visited Changzhou. A certain Zhu, a peddler, suddenly developed a strange disease: severe aversion to cold. Warm medicines failed. Hot medicines like Gui Fu (Cinnamon and Aconite) worsened the cold. I examined him. All pulses were deep. Pressing to the bone, they were slightly rapid. I recognized this as a "Same Qi Seeking" syndrome. I prescribed Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction). Zhu, humble in status, was honored by my visit and took the prescription immediately. One dose reduced coldness; three doses cured him. Such symptoms—body cold, deep pulse—are usually treated with hot medicines. However, hidden Heat in deep layers, when attracted by hot medicines, draws Defensive Yang inward, causing external aversion to cold. Zhu was fortunate to take few hot medicines, allowing rescue. If hot medicines were abused, as in Mr. Langshan's case with Gong or mine with Yu, just a few doses would deplete True Yin, trigger Liver Wind, and become incurable. How can pulse diagnosis be neglected?
Treatment Efficacy for Li Chusheng's Eye Disease: Third Brother Li Chusheng suffered from eye disease in both eyes, worse in the left. Severe redness and pain, unable to open eyes. Forced opening resulted in blindness. Unbearable headache, worse on the left. Strangely, extreme thirst for drinking, consuming ten bowls of strong tea daily. Doctor Cai prescribed Bai Hu Tang (White Tiger Decoction), using Shi Gao (Gypsum Fibrosum) about 1 liang per dose. Thirst increased with usage. After several doses, tea intake rose to thirty bowls. Loss of appetite, mental restlessness, insomnia, drinking day and night for over two months. Exhaustion ensued. I examined him. Pulses were wiry, rapid, and large. The Right Guan pulse was particularly rapid and lacked gentleness. I smiled, "This is not a Bai Hu Tang syndrome." Bai Hu Tang treats Shanghan seasonal pathogens with Stomach Excess Heat, characterized by extreme thirst for cold drinks. Here, thirst accompanies eye disease, desire for hot drinks, not cold. Long-term strong tea consumption damages Stomach Qi and dries Stomach fluids. Seeking moisture, drinking more actually harms further, increasing thirst. Shi Gao treats Excess Heat, not Deficiency Heat. Materia Medica warns against using it in deficiency to avoid damaging Stomach Qi. Mediocre doctors do not know this, assuming thirst requires Gypsum, ignoring the vast difference between Exterior/Interior disorders and the subtle distinction between hot/cold drinks. Reckless prescribing harms eyes and life.
His second brother, a scholar, asked, "The eyes belong to the Liver. Why does an eye disease cause such severe Stomach issues?" I replied, "It is known that the Liver opens into the eyes. It is known that Liver and Kidney share the same source; Liver deficiency leads to Kidney deficiency. But it is unknown that Qi and Blood of the Five Zang, Six Fu, Twelve Meridians, and 365 Collaterals are derived from Spleen Earth, ascending to the eyes to provide clarity. Thus, Spleen deficiency causes loss of essence from all Zang, preventing clarity in the eyes. Spleen and Stomach are exterior-interior pairs. Spleen transports essence for the Stomach. Stomach governs descending, Spleen governs ascending. Stomach descends, then Spleen ascends. Food enters Stomach, essence floats and spreads, transmits downward to Spleen. Spleen scatters essence upward to Lungs. Now, Stomach fluids are dry, Stomach Qi does not descend. What essence can Spleen ascend to bring clarity to the eyes? Moreover, the patient has inherent Liver/Kidney deficiency. Kidney fails to nourish Liver. Liver deficiency generates Heat. Excessive Heat generates Wind. The long-deficient Stomach is attacked by Wood/Fire. Hence, unbearable dryness/heat, drinking doesn't quench thirst, lack of harmonious Stomach Qi, loss of appetite. 'When Stomach is disharmonious, sleep is restless,' hence insomnia. Eye pain belongs to Liver Fire; headache belongs to Liver Wind. To treat these, one must first save the Stomach. Saving the Stomach requires quitting tea. Then, strongly nourish Stomach Yin, and nourish Liver/Kidney. Stomach likes purity/harmony; with moisture, Qi descends. Wood deficiency/dryness needs moistening to calm Fire. Calmed Fire stops Wind. No Fire in eyes means no disease; no Wind in head means no pain. With such regulation, dangerous symptoms are manageable. Patient worried about quitting tea. I said, 'Not quitting water, only quitting tea.' Used Chrysanthemum and Mulberry Leaf as tea substitute. First administered heavy Stomach-nourishing and Qi-supporting decoction. After ten days, no desire for tea. Then adjusted Liver/Kidney, cleared Lung to generate Water source, or cleared Heart to drain Liver Heat. Through various methods, gradual recovery. Two years later, his father had eye disease. Doctor Cai claimed he could cure it without me. Result: one eye blinded.
Treatment Efficacy for Commander Bo Suian's Ear Condition Near Death: Commander Bo Suian of Jingkou. I taught at his home at age thirty. Close friends, like siblings. Thirty-plus years passed. Suian was upright, never indulged in lust/opium. But in his twenties, first trip to Beijing, lacking caution, contracted filth at an unknown inn. Nodules appeared on head, resembling Chancre (Guang Chuang). Urgent surgical treatment with topical applications healed it quickly. Over a year later, Chancre (Xia Gan) developed. Surgical treatment failed for a long time. I advised Xian Yi Liang Tang (Immortal Remnant Grain Decoction) with Wu Bao Dan (Five-Treasure Pill). Gradual recovery followed. Suian feared taking medicine. Post-recovery, lack of thorough cleaning led to Yin Tinea (Yin Xuan). Spread from waist down to abdomen above, no gap, extreme itching. Yet, for 32 years, no other illnesses. Unexpectedly, in the 11th year of Daoguang, someone taught him to treat tinea using Zijing Pi (Broussonetiae Cortex) powder mixed with Bai Ji (Polygonati Rhizoma) juice applied topically. I heard this, urged him repeatedly not to treat it, as tinea is not worrisome. Curing it might cause other issues. Suian was misled, ignored my advice. Applied these two medicines daily to lower body from autumn to winter. Tinea completely disappeared, no itching, very pleased. After the full moon in November, sudden ear pain. I examined his pulse. At that time, Governor Yunting suddenly had hemoptysis, inviting me urgently. After examining Suian, I packed for the province. I told my sons, "Suian's pulse is very bad. Serious illness likely. I am away, what to do?" Sons agreed, as he seemed normal, my words seemed inaccurate. One month in the province, I received letter: Suian critically ill, life hanging by a thread, requested immediate return for farewell. Shocked. Fortunately, Governor recovered. Bought boat south, reached Zhenjiang in one day. Visited Bo residence. Ear and neck swollen, thick pus dripping, foul odor unbearable. Patient barely breathing, unable to swallow rice/water for nine days. Seeing me, could speak little, only said, "Though you came, I will not take medicine." Asked son why refusal. Son said, many internal/surgical medicines taken in a month, mostly cooling, leading to Stomach failure. Hence, Suian vowed not to take medicine.
I turned to Suian, "Brother, only I know your disease origin. Others cannot know. Ignorant doctors see ordinary Fire-Toxin, insist on cooling medicines. Know this disease cannot use cooling, but should use warming. If you take my medicine, effective in three doses. If not, then refuse medicine, how about that?" Hearing warm replaces cooling, Suian nodded. I prescribed modified Gui Pi Tang (Restore the Spleen Decoction), plus Wu Bao Dan with Western Buffalo Horn (Xi Niu Huang) taken separately. After three doses, odor decreased, appetite opened, spirit revived. Suian asked, "What medicine is so magical?" I smiled, "Your disease root is from thirty years ago. Other doctors couldn't know, nor did you remember. You contracted evil qi, mistakenly used topical medicine, changed to Chancre. Post-healing, lack of cleaning, gradually became Yin Tinea. This tinea was the exit for residual qi, and damp-heat from whole body exited here. Originally, absolutely no need to treat. But you listened to others, wanted to cure it, succeeded. But where did wind-damp-heat-toxin go? Unknowingly, it attacked clear orifices. Also, conflict with military commander, retired/dismissed. Though generally open-minded, forced circumstances, heart not smooth. Heart connects to ear orifice, thus disease manifested in ear. Doctors didn't know, abused cold/cooling, trapping heat-toxin, creating foul odor unlike usual. Human Spleen/Stomach like fragrance, hate stench. This stench accumulates in Stomach, how can Stomach Qi not fail? Expect delicious food? Method for treating residual qi focuses on lifting and penetrating. Especially supporting Righteous Qi. Residual qi is Evil Qi. When Righteous Qi declines, Evil sinks inside. When Righteous Qi prospers, Evil is pushed out. Common mediocre doctors treat damp-toxin with bitter-cold purgatives, rarely succeed. Truly ignorant of medical principles. Your case details are complex, hard for doctors to understand, easily blamed. My Gui Pi Tang method nourishes Heart, strengthens Spleen, supports Stomach, opens depression, builds Middle, expels Evil. Plus modified Wu Bao Dan, precious ingredients, defeat/toxin search, specifically pushing outward, preventing internal accumulation. Proper medication seems divine. Although currently effective, tinea must reappear for final success. Days later, tinea itched. Ten-plus days later, tinea covered lower body, ear disease fully cured, diet doubled. Always used this one prescription, unchanged. Returning from province, seeing Suian's state, I doubted salvation, yet achieved rapid effect. Perhaps Heaven's will, not human effort alone."