枳园名经宣，字子顺，高端氏。文化、方政之间，以医鸣于京师。救济之泽，洽于一时
。致
仕之后，隐于鹰峰，优游自养，卒年七十有三。枳园生于枫亭、台州、东郭诸人之后，治术
融会，颇有机警，所着《医谱》、《方谱》、《药谱》、《认证录》等，足以窥其一斑，今
录一二，以备省觉。其他三角、小林竹中、有持诸人，亦声誉相踵，而余未能详之，故期他
日云。
诊病有四因、六证、十二候、三诊、七视。四因者，谓外因、内因、内外别因、内外合
因。
六证者，谓初、中、终、顺、险、逆。十二候者，谓寒、热、虚、实、浅、深、缓、急、平
、间、常、变。三诊者，谓持脉、按腹、审禀。七视者，谓问原、寻证、望色、观形、听声
、嗅气、谛习。盖此五法三十二则，乃和汉往圣先贤之遗训，而吾门之所历验。苟审诊视察
病源证候者，不可不精究焉。
瘟疫初起，食不减，味不变，精神爽慧，起居如故者，必至热解。食将进时食反减，或
绝谷
元气衰弱者，间有之，与轻疫食不减者不可混。凡瘟疫自初起至热解，食不进者，不足深虑
也。
其人卒然晕倒，不省人事，醒后精神恍惚，或两脚痿弱不能起，尔后身体灼热，口舌干
燥，
时时谵语，或言语错谬，自汗出，痰喘壅盛而烦躁，其状如中风，半身不遂。或下利呕逆，
或哕逆。或四肢微冷者，医不知而为风治之，误也。是瘟病热剧，直传于里，元气衰弱之所
致。虚禀者及老人多患之，选用柴胡润燥汤、柴胡栝蒌汤。若痰喘者，宜蒌贝养荣汤，然多
属不治。
瘟疫淹缠不解，或邪气沉沦，遽然变为香港脚者，属危候。
瘟疫初起，手指微抽着，后必发痫，多难治。
伤寒、瘟疫、疟痢、霍乱瘥后，有发香港脚者，或有病不解变成香港脚者，世医不知，而为
病后水气治之，遂至冲心而死，不可不慎焉。
产后香港脚，四肢产 痹软弱，难起居，心中烦悸，腹中不仁，体常烦热，或洪肿或微肿
，或
胖胀，筋脉弩 ，或 羸筋脉挛急，小便不通，脉紧有力者，宜犀角麻黄汤。医不知而见其
头疼、冲气、恶露少等证，为血气之所为，与调血剂者，误也。
风肿之为病，在上则耳后项际，在中则胸膺肩背，在下则腿股胫 。流注为肿，其状如
痈，
或壅或漫，或痛或不痛，或消散，或溃脓，其初见憎寒壮热，头疼体痛等表证也。风肿在耳
后项际者，大则如栾子，小则似梨子。而见前表证者，宜荆芥败毒散。
风肿初起，不辨伤风时气者，见憎寒壮热，头疼体痛，而有表证解后发者，或有表证中
见肿
胀而热随解者，或有寒热发作有时如疟状，或有身热无间断，其状似温病者，俱皆自初为肿
，而至其变，或未为肿，或有表证绝无，而但为肿也。
麻疹初起自汗出者，邪从汗而解。呕吐者，邪从上焦而解。吐泻兼发者，邪从上下二焦
而解
。鼻衄者，邪从血而解。皆麻疹之佳兆也，不可遽与止汗镇兜涩血之剂。疹快发则诸证自愈
。
麻疹初起，与排毒、升麻、葛根、解肌、越婢、连翘、凉膈等汤。不发透者，乃为瘟气
收束
疹毒之所致，与启蕴汤以散瘟气，则必出透也。(按∶启蕴汤系高端之家方，柴胡、黄芩、
浓朴、半夏、草果、枳实、甘草、生姜，俱八味，盖九味清脾汤变制也。
麻疹已出，其色如丹朱不红活，麻沙混淆不匀净，地界淡红或微黯，发热烦渴，睛多赤
络，
口臭甚，唇舌干燥或焦裂，躁扰不宁，小便涩少，大便不通者，乃为热毒内伏，燔灼血液之
所致。凉血攻毒饮，加犀角、石膏，或兼服独圣散、紫雪等。疹已出，或焦紫，或红斑、壮
热如炙，烦渴引饮，小便赤涩，大便秘硬，口气加混，惊狂谵语，烦躁不安者，宜郁金散，
服后暂就眠，则精神即爽然。
之为病，上在鸠尾胁肋，中在脐上左右，下在少腹左右，或浮现于上面，或沉着于下
底，
或支两胁，或侵两胁，其形或圆或椭，或匾或浓，大者如拳球，如盘鳖，小者似卵茄，似梨
杓，或坚硬如石，或柔韧如肉，或软虚如绵，或牵挛肩背，或引拘脊膂，或疼痛，或不疼痛
，或脐下无力，或腹内觉狭小，脉多沉迟者也。病在少腹，初起小如桃栗，或鸡蛋，或似茄
子、梨实，渐长大。久之，其状如怀胎而正圆，或蹲踞不匾长，不成棱 。大者充满腹中，
宛如南瓜状，在正中，或微倚左右，按之浮凸，或沉着不移。其处无痛，或虽痛亦不剧，月
信以时下，或经血过多，其块必膨胀，饮吃谈笑如故。但俯则觉妨碍耳，名曰肠覃。此证难
愈。虽不愈，不为大害，或其状如怀胎，经年月则渐减至如初。若当覃始萌时，早服通气松
滞之剂，则或可防之，宜乌苓通气散。
解劳、缓 二汤之所治，系将为劳之兆。故二方俱腹力虚软者，加人参。微咳者，加贝
母、
桑白皮。热深者，加地骨皮效。(枳园所自验自古经方，至俗间单方而又出于自制者，居四
之一，如缓 汤、润肺汤九味柴胡汤之类，今用之屡得效矣。)
疝热甚时谵语，或口渴舌燥，或黄胎、或白胎，大便如热痢，小腹拘急，腰臀下迫难忍
者，
宜融疝散。窘迫重坠甚者，加大黄。疝无触犯之因，卒然小腹坚硬，痛难忍，或从右，或左
上抢冲胁，胁气急息迫，手不可近，烦闷扰乱，身热甚似温病，口渴舌燥，小便不利，大便
秘，或呕吐恶心，或时呃逆，从少腹直上冲心下，或下牵阴囊，但坐不能卧，或肚腹臌胀，
弹之为声者，名曰冲疝。其证多属热，宜融疝加大黄汤。
婴孩或幼少时颈有结核者，俗称为痨之兆。虽未必然，间亦有之，不可不知。(按∶金
匮·虚劳篇》云∶肠鸣马刀侠瘿者，皆为劳得之。古人以颈核为劳，是其一征。)
虚劳初起，腹肚胀满坚硬而痛，或引少腹咳嗽，盗汗有微热，食了腹乍膨闷，或食不进
，大
便多泻，甚者日四五行，或时下肠垢，下后腹中稍觉快，若不下，则胀益坚实，而短气烦闷
，颈脉甚动，或口咽干燥欲呕，或四肢微肿，而趺上丰满，或喉间微响，时鼻扇，或腹肚疼
痛难忍，身体疲困者，吾门谓之腹胀劳。而素有 癖而发劳者，多属不治。若与柴平汤、柴
胡槟榔汤，大便渐硬，腹胀随减，痛止热退者，为佳兆，此证在虚劳颇为逆候，世医不知，
而漫认为胀满，大误也。
伤寒桂枝证兼呕吐者，多因停饮拒格微邪。故治停饮则邪从解，是以不与桂枝汤而与和
解汤也。
发散剂加气药，则其效反捷，此气道疏而邪自祛也。如大邪非此例。(家君于二陈汤加
葛根
、羌活、桔梗，治轻浅风寒，即此意。按丰公征韩之役，人多得外感，医投以不换金正气散
无效。鬼将军部下有老医，与以香苏散立验。人问其故。曰∶远征人多兼气郁，非气剂则不
能达焉。北山寿安曰∶近来医家唯以香苏散治感冒时气，气滞头痛痞满，香港脚皱脚等，而不
言能解食毒之功，亦阙典也。皆与此条相发宜参考焉。)
温病里证悉具，而舌上白胎滑者，认为脏结，不可失下，能审他证具而可下之。平素大
便秘
涩者，得温病忽粘滑，或 溏，此非因胃虚邪气猖獗之所使，缓漫失下，则胃气消烁，噬脐
无及。
人方汤浴时，身如被束缚，或如灌冷水者，肌表有热也。
《千金方》以浮为表脉，以沉为里脉，而医家奉为典型。余质之于实际，浮有病散脱之
候，沉有病收闭之候，而此二脉阴阳俱有之，概不可为表里。
夏月因暑热遗尿者，宜白虎加人参汤。(按∶或云三阳合病条遗尿二字，疑当在发汗则
谵语下。此说似有理，然有间属实者，宜于实际而征焉。)
有人临卧时肩背如负千斤重，渐及通身，须臾冷汗淋漓，烦悸难堪，而其苦顿止者，发
中风或支饮之兆也。
风病昏绝，须臾醒又发者，为难治。
中风醒后，诸证稍缓，但肩 接骨分离不遂者，为难治。若分离不甚者，间得痊。香港脚
无手
足麻痹、软弱、肿胀、筋挛等，唯心下微急，小腹不仁，食如常。食已短气，卧则气息稍平
，其人上体丰满，下部削小者，此欲上冲之候，不可忽视。
干香港脚声嗄咽中痰壅者，多死。
支饮、香港脚、产后血气三病，其证大同，而其源大异，不可混治，宜以脉辨之。脉大按
之虚
无力者，支饮也。脉洪数按之紧有力者，香港脚也。脉软弱而数，按之中止者，产后血气也。
(按∶此三病本不同，证亦有所区别，宜审焉。)
肺痿咳嗽吐沫颇已，其人忽吐血发热者，为恶候。
久咳不止，唾血引红线，或为点斑者，属肺损，虽外候似轻，最为难治。余为制一方，
即于桔梗汤方中加白芨、桑白皮，名白芨汤。
虚劳吐红不一，有痰中引血缕者，有痰中为粒颗者，其大或如蚕豆，或如赤豆、绿豆，
见血虽小，不可忽诸。
久咳唾血如红缕，或为点斑者，此属肺损，他证虽微，终至难治，早可与白芨汤。世所
谓不
食病，即《医级》所载神仙劳之类。此证妇人尤多，男子至少。或馋嗜焦饼豆糕，或喜食果
瓜、生菜、昆布、海苔。其甚者，绝谷粒，唯饮水，而肌肉润泽，卧起步动如常，小便能利
，大便秘涩，口干贪饮，以至年余，其病多出于郁气，故宜气剂而不宜补住也。
人无故饮食减少者，将发大患之兆，当摄养。若缓漫失期，则药饵灸 无及。盖此证有
暴渐之别，暴减者可治，渐减者难治。一种有神仙劳者，虽不食，与此证自异。
哮喘脉数属阴虚火动者，宜滋阴降火汤。若里邪实，大便不通，脉实者，宜承气汤。
幼时患哮喘者，一旦治之后，有发癫痫或心风者，又有痫疾者，皆系先天遗毒，故为难
治。
幼少时患哮喘者，治之后，多变癫、痫、狂、心风四病，或有不服药自变此四病者，又
有初
患痫，治后变哮喘者，又有幼少无事，壮岁始患此五病者，俱系先生遗毒。但因其人体气有
迟速耳，吾门皆名之曰胎病。(胎病名出于《素问·奇病论》，可以征焉。)
风痰家时发热恶寒头痛，身体疼痛，或肩背强急，或咽喉签痛者，皆痰之所为，非感冒
也，俗名曰痰风。
胸痹痛在皮肉间者，为恶候。
背胛或右或左拘痛，动摇则益剧，而其痛骤去者，多变为胸痛。状与胸痹相似，而筋脉
纠戾之所致。故气急妨闷，饮食微噎。其痛亦与胸痹彻痛不同也，宜《本事方》桂心散。
哕逆与热药无效者，属壅热，以泻心汤、麻沸汤，服则速愈。(按∶《万病回春》以黄
连解
毒汤、白虎汤，治伤寒热证。医者误用姜桂等药，助起火邪，痰火相搏而呃逆，即同旨。)
其人食味皆苦，或甘醋或酸涩者，将发噎之候，但觉苦者为易治。
打扑伤损，瘀血不去，历年后卒然气急，心下逆抢，或昏冒不知人，或妄语，或健忘者
，是即瘀血作风状者。
水肿遍身满肿，唯两手 肉脱而枯柴者，为不治。
妇人手足麻痹者，多七情郁结，经络凝滞之所致也。正气天香汤，或香苏散、二陈汤相
合加乌药。
妇人素郁闷，牝户觉痛痒，时水液渗出，饮食少思，肢体倦怠者，宜加味归脾汤。心中
失血
养，则必为怔忡，故治此证宜选用四物、八珍、十补、人参、养荣诸汤，俱加麦门、酸枣仁
为佳。
患肠风者，概为气急耳鸣，而偶无之。唯目眩头晕者有之，不可不知。
头晕属实者，宜防风通圣散加菊花。
其人无故梦寐恍惚，语言妄错，两手微颤，颜耳潮红，或时喜笑，或作持握状，剧则为
瞪视
状，须臾觉悟，爽慧如故。此人多壮实，饮食失宜，七情乖错，因劳动倦怠，热痰壅蔽心窍
之所为，名曰心慌。不急治，则必发风痫，至不救。其始发密陀僧丸，而后宜清神汤，加减
清神汤。
人值雨湿则必腰痛者，宜渗湿汤、除湿汤类。
人卒然盗汗出而不止，饮食起居如故，气亦爽快，大便自调，小便才少者，是水饮渗溢
毛孔之
所致。早利其小便则愈，宜茯苓甘草汤，不必须止汗涩收之剂。若小便不利而汗血止者，后
必发水肿或下利，不可不知。
耳鸣唯闻鸣钟柝声，而不能闻他声音，欲聋之兆也。
痫疾有跗上或膝盖痛者，可不与历节混。
小儿十岁前后肛门生小虫，数十为群，或数百围如鬼灯状，痛痒难堪者，至弱冠多发劳
瘵。
龟胸名恐不的，当称鸡胸似是。盖鸡胸病证在幼稚为疳，在少壮为痫也。
婴儿生七八月无病，至九十月渐肌肉肥胖，时时发热，如外感，或如疟，吐乳青便，顶
颅
光莹，囟门或填满，或凹陷，睡中微抽者，将发阴痫之兆。庸医不知，认为胎肥，可笑。
儿四五岁，鼻衄血月一次或二三次，每次五六勺，多至数合，其血黯紫而稠粘，或鲜红
而稀
薄。当其发，必气逆面赤，手足微冷，消谷善饥，大便秘，小便数也。此证有乳癖腹痛后发
者，有痘后发者，《千金》竹茹汤方中去芍药、人参、术桂，加麦门冬、黄 、栀子、升麻
【背景信息】
书名：先哲医话 章节：高端枳园(1/2) 类别：医论
【正文翻译】
枳园名叫经宣，字子顺，姓高端。他在文化、方政年间，以医术闻名于京城。他的救济恩泽，惠及当时众人。退休之后，他隐居在鹰峰，悠闲自得地修养身心，享年七十三岁。枳园出生于枫亭、台州、东郭等名医世家之后，医术融会贯通，颇有机智警觉之处，所著《医谱》、《方谱》、《药谱》、《认证录》等书，足以窥见其学术风貌的一斑，现摘录一二，以备反省觉悟。其他如三角、小林竹中、有持等人，也声誉相继，但我未能详知，故期望日后补充。
诊病有四因、六证、十二候、三诊、七视。四因，指的是外因、内因、内外别因（既非纯外也非纯内）、内外合因（内外邪气结合）。六证，指的是初、中、终、顺、险、逆六种病情阶段或性质。十二候，指的是寒、热、虚、实、浅、深、缓、急、平、间、常、变十二种病候表现。三诊，指的是切脉、按腹、审察禀赋体质。七视，指的是询问病因原委、寻找症状依据、望面色、观形体、听声音、嗅气味、仔细研习观察。这五种方法共三十二条规则，是和汉历代圣贤留下的训诫，也是我们要门亲身验证过的。如果审慎诊断以考察病源证候的人，不可不精研这些内容。
瘟疫初起时，饮食不减，味觉不变，精神清爽聪慧，起居如常的，必定会热退病解。如果在即将进食时反而食欲减退，甚至绝食，导致元气衰弱的，这种情况偶尔也有，但不能与轻症瘟疫中饮食不减的情况混淆。凡是瘟疫从初起到热解期间，饮食不进的患者，不必过度忧虑。
有人突然晕倒，不省人事，醒来后精神恍惚，或者两脚痿弱不能站立，随后身体灼热，口舌干燥，时常说胡话，或者言语错乱，自汗出，痰喘气盛而烦躁，症状像中风，半身不遂。或者下利呕吐，或者呃逆。或者四肢微冷的，医生不知道这是瘟病，误当作风病治疗，这是错误的。这是瘟病热势剧烈，直接传入体内，导致元气衰弱所致。禀赋虚弱的人及老人多患此病，选用柴胡润燥汤、柴胡栝蒌汤。如果有痰喘症状的，宜用蒌贝养荣汤，但大多属于难治之症。
瘟疫缠绵不解，或者邪气沉伏，突然变成香港脚（脚气病）的，属于危重证候。
瘟疫初起时，手指微微抽搐的，后来必定发作痫病，大多难以治疗。
伤寒、瘟疫、疟疾痢疾、霍乱病愈后，有发作香港脚（脚气病）的，或者有病未解转变为香港脚（脚气病）的，世俗医生不知道，误当作病后水气病治疗，导致邪气上冲心脏而死，不可不谨慎啊。
产后香港脚（脚气病），四肢麻木痹痛软弱，难以起居，心中烦闷心悸，腹部感觉迟钝，身体经常烦热，或者全身洪肿或轻微肿胀，或者肥胖胀满，筋脉紧绷僵硬，或者肌肉消瘦筋脉挛急，小便不通，脉象紧有力的，宜用犀角麻黄汤。医生不知道，见到其头疼、冲气上逆、恶露少等症状，认为是血气问题，给予调血药剂，这是错误的。
风肿这种病，在上部则位于耳后颈项际，在中部则位于胸膺肩背，在下部则位于腿股胫骨。流注形成的肿胀，形状像痈疽，或者壅聚或者弥漫，或者疼痛或者不疼痛，或者消散或者溃烂流脓，初起时有憎寒壮热、头疼体痛等表证。风肿在耳后颈项际的，大的像栾树果实，小的像梨子。出现前述表证的，宜用荆芥败毒散。
风肿初起，如果不辨别是伤风还是时气，出现憎寒壮热、头疼体痛而有表证解除后发作的，或者有表证中见肿胀而热随表解的，或者有寒热发作有时像疟疾状的，或者有身热无间断，症状像温病的，都是从初起为肿，直到变化，或者尚未为肿，或者有表证完全没有，仅仅表现为肿。
麻疹初起自汗出的，邪气随汗而解。呕吐的，邪气从上焦而解。吐泻兼发的，邪气从上下二焦而解。鼻衄（流鼻血）的，邪气从血分而解。这些都是麻疹的良好征兆，不可急于使用止汗、镇兜、涩血的药剂。疹子透发顺畅，则各种症状自然痊愈。
麻疹初起，使用排毒、升麻、葛根、解肌、越婢、连翘、凉膈等汤剂。如果不透发的，是因为瘟气收束疹毒所致，给予启蕴汤以疏散瘟气，则必定能透发出来。（按：启蕴汤是高端氏的家传方，由柴胡、黄芩、浓朴、半夏、草果、枳实、甘草、生姜组成，共八味，大概是九味清脾汤的变制方。）
麻疹已经发出，颜色像丹朱但不红活，疹点沙粒状混杂不均匀洁净，底色淡红或微暗，发热烦渴，眼睛多有赤络，口臭严重，唇舌干燥或焦裂，躁扰不宁，小便涩少，大便不通的，这是热毒内伏，燔灼血液所致。可用凉血攻毒饮，加犀角、石膏，或者兼服独圣散、紫雪等。疹已发出，或者焦紫，或者红斑、壮热如炙烤，烦渴引饮，小便赤涩，大便秘硬，口气加重混浊，惊狂谵语，烦躁不安的，宜用郁金散，服用后暂时睡眠，则精神即刻清爽。
[此处原文缺字，推测为“瘕”或类似积聚病名]这种病，上部在鸠尾胁肋，中部在脐上左右，下部在少腹左右，或者浮现于表面，或者沉着于底部，或者支撑两胁，或者侵犯两胁，形状或者圆或者椭圆，或者扁平或者隆起，大的像拳球，像盘鳖，小的似卵茄，似梨杓，或者坚硬如石，或者柔韧如肉，或者软虚如绵，或者牵引肩背，或者引起脊背拘急，或者疼痛，或者不疼痛，或者脐下无力，或者腹内觉狭小，脉象多沉迟。病在少腹，初起小如桃栗，或鸡蛋，或似茄子、梨实，逐渐长大。久了，形状像怀孕而正圆，或者蹲踞不扁长，不成棱角。大的充满腹中，宛如南瓜状，在正中，或者微倚左右，按压浮凸，或者沉着不移。该处无痛，或者虽痛也不剧烈，月经按时来潮，或者经血过多，肿块必定膨胀，饮食谈笑如常。只是俯身时觉得妨碍，名叫肠覃。此证难愈。虽然难愈，不为大害，或者其状像怀孕，经过年月则逐渐减少至如初。若在肠覃始萌芽时，早服通气松滞的药剂，则或许可以防止，宜用乌苓通气散。
解劳、缓 [缺字，疑为“急”或类似字] 二汤所治疗的，是将成为劳损的征兆。所以这两方都适用于腹部力量虚软者，加人参。微咳者，加贝母、桑白皮。热深者，加地骨皮有效。（枳园所亲自验证的，从古方经方，到俗间单方又出自自制的，占四分之一，如缓 [缺字] 汤、润肺汤、九味柴胡汤之类，现在使用屡获疗效。）
疝气热势严重时说胡话，或者口渴舌燥，或者舌苔黄、或者舌苔白，大便像热痢，小腹拘急，腰臀部下迫难忍的，宜用融疝散。窘迫重坠严重的，加大黄。疝气没有触犯诱因，突然小腹坚硬，痛难忍受，或者从右，或者左上抢冲胁部，胁部气急呼吸紧迫，手不可近，烦闷扰乱，身热甚像温病，口渴舌燥，小便不利，大便秘结，或者呕吐恶心，或者时呃逆，从少腹直上冲心下，或者下牵阴囊，只能坐不能卧，或者肚腹臌胀，弹击有声的，名叫冲疝。此证多属热，宜用融疝加大黄汤。
婴孩或幼小时颈部有结核的，俗称为痨病（肺结核）的征兆。虽然不一定如此，但也有这种情况，不可不知道。（按：《金匮要略·虚劳篇》说：肠鸣马刀侠瘿者，皆为劳得之。古人以颈核为劳，这是其中一个征象。）
虚劳初起，腹肚胀满坚硬而痛，或者牵引少腹咳嗽，盗汗有微热，吃完饭后肚子突然膨闷，或者吃不进饭，大便多泻，严重的每天四五次，或者时下肠垢，排便后腹中稍觉舒服，如果不排便，则胀更加坚实，而短气烦闷，颈脉跳动明显，或者口咽干燥想吐，或者四肢微肿，而足背丰满，或者喉间微响，时而鼻翼扇动，或者腹肚疼痛难忍，身体疲困的，我们要门称之为腹胀劳。而素有癖块而发作劳损的，多属难治。如果给予柴平汤、柴胡槟榔汤，大便渐渐变硬，腹胀随之减轻，痛止热退的，是佳兆，此证在虚劳中颇为逆候，世俗医生不知道，而随意认为是胀满，是大错误。
伤寒桂枝证兼呕吐的，多因停饮拒格微邪。所以治疗停饮则邪气自解，因此不与桂枝汤，而与和解汤。
发散剂加入行气药，则疗效反而快捷，这是因为气道疏通而邪气自然祛除。除非是大邪，否则不在此例。（家父在二陈汤中加入葛根、羌活、桔梗，治疗轻浅风寒，就是这个意思。按：丰公征韩之役，许多人得了外感，医生投以不换金正气散无效。鬼将军部下有一位老医，给予香苏散立即见效。人们问其原因。他说：远征之人多兼气郁，不用气剂则药力不能到达。北山寿安说：近来医家只用香苏散治疗感冒时气，气滞头痛痞满，香港脚（脚气病）皱脚等，而不提它能解食毒的功效，这也是缺失的典章。这些都与此条相互启发，宜参考。）
温病里证悉具，而舌上有白胎滑腻的，认为是脏结，不可错过攻下的时机，能审察其他证具备且可下的情况下使用。平素大便秘涩的人，得了温病忽然变得粘滑，或者溏泄，这不是因为胃虚邪气猖獗所致，如果缓慢失下，则胃气消烁，后悔莫及。
人正在汤浴时，身体像被束缚，或者像灌冷水的，这是肌表有热。
《千金方》以浮脉为表脉，以沉脉为里脉，而医家奉为典型。我质疑于实际，浮脉有病散脱的征候，沉脉有病收闭的征候，而这二脉阴阳俱有，一概不可作为表里的判断标准。
夏季因暑热遗尿的，宜用白虎加人参汤。（按：有人说三阳合病条中的遗尿二字，怀疑应当在发汗则谵语之下。此说似乎有理，然而也有属实证的情况，宜在实际中验证。）
有人临睡时肩背像背负千斤重，逐渐波及全身，须臾冷汗淋漓，烦悸难堪，而其痛苦顿时停止的，是发作中风或支饮的征兆。
风病昏厥，须臾醒后又发作的，为难治。
中风醒后，诸证稍缓，但肩关节接骨分离活动不遂的，为难治。若分离不严重的，偶尔能痊愈。香港脚（脚气病）无手足麻痹、软弱、肿胀、筋挛等，唯心下微急，小腹不仁，饮食如常。吃完饭后短气，躺下则气息稍平，其人上体丰满，下部削小的，这是欲上冲的征候，不可忽视。
支饮、香港脚（脚气病）、产后血气三病，其证大同，而其源大异，不可混治，宜以脉象辨别。脉大按之虚无力的是支饮。脉洪数按之紧有力的是香港脚（脚气病）。脉软弱而数，按之中止的是产后血气。（按：此三病本不同，证也有所区别，宜审慎。）
久咳不止，唾血带红线，或者为点斑的，属肺损，虽然外候似轻，最为难治。我制定一方，即在桔梗汤方中加入白芨、桑白皮，名叫白芨汤。
虚劳吐红不一，有痰中带血缕的，有痰中为颗粒的，大小或如蚕豆，或如赤豆、绿豆，见血虽小，不可忽视。
久咳唾血如红缕，或者为点斑的，此属肺损，他证虽微，终至难治，早可与白芨汤。世所谓不食病，即《医级》所载神仙劳之类。此证妇人尤多，男子极少。或者馋嗜焦饼豆糕，或者喜食果瓜、生菜、昆布、海苔。严重的，绝谷粒，唯饮水，而肌肉润泽，卧起步动如常，小便能利，大便秘涩，口干贪饮，以至年余，其病多出于郁气，故宜用气剂而不宜补住。
人无故饮食减少的，是将发大患的征兆，应当摄养。如果缓慢失期，则药饵灸治无及。盖此证有暴减和渐减的区别，暴减者可治，渐减者难治。一种有神仙劳的，虽然不食，与此证自异。
哮喘脉数属阴虚火动的，宜滋阴降火汤。若里邪实，大便不通，脉实的，宜承气汤。
幼时患哮喘的，一旦治愈后，有发癫痫或心风的，又有痫疾的，皆系先天遗毒，故为难治。
幼少时患哮喘的，治愈后，多变癫、痫、狂、心风四病，或者有不服药自变此四病的，又有初患痫，治愈后变哮喘的，又有幼少无事，壮岁始患此五病的，俱系先生遗毒。只是因其人体气有迟速而已，我们要门都名叫胎病。（胎病名出于《素问·奇病论》，可以验证。）
风痰患者时常发热恶寒头痛，身体疼痛，或者肩背强急，或者咽喉肿痛者，皆痰之所为，不是感冒，俗名叫痰风。
背胛或右或左拘痛，动摇则加剧，而其痛骤去的，多变为胸痛。状与胸痹相似，而是筋脉纠戾所致。所以气急妨闷，饮食微噎。其痛也与胸痹彻痛不同，宜用《本事方》桂心散。
呃逆与热药无效的，属壅热，以泻心汤、麻沸汤，服用则速愈。（按：《万病回春》以黄连解毒汤、白虎汤，治疗伤寒热证。医者误用姜桂等药，助起火邪，痰火相搏而呃逆，旨趣相同。）
其人食味皆苦，或者甘醋或者酸涩的，将发噎膈的征候，但觉苦的为易治。
打扑伤损，瘀血不去，历年后突然气急，心下逆抢，或者昏冒不知人，或者妄语，或者健忘的，是即瘀血作风状者。
妇人手足麻痹的，多七情郁结，经络凝滞所致。正气天香汤，或者香苏散、二陈汤相合加乌药。
妇人素郁闷，牝户觉痛痒，时水液渗出，饮食少思，肢体倦怠的，宜加味归脾汤。心中失血养，则必为怔忡，所以治此证宜选用四物、八珍、十补、人参、养荣诸汤，俱加麦门冬、酸枣仁为佳。
患肠风的，概为气急耳鸣，而偶无之。唯目眩头晕的有之，不可不知。
其人无故梦寐恍惚，语言妄错，两手微颤，颜耳潮红，或者时喜笑，或者作持握状，剧则为瞪视状，须臾觉悟，爽慧如故。此人多壮实，饮食失宜，七情乖错，因劳动倦怠，热痰壅蔽心窍所致，名叫心慌。不急治，则必发风痫，至不救。其始发密陀僧丸，而后宜清神汤，加减清神汤。
人突然盗汗出不止，饮食起居如故，气亦爽快，大便自调，小便才少的，是水饮渗溢毛孔所致。早利其小便则愈，宜茯苓甘草汤，不必须止汗涩收之剂。若小便不利而汗血止的，后必发水肿或下利，不可不知。
耳鸣唯闻鸣钟柝声，而不能闻他声音的，是欲聋的征兆。
小儿十岁前后肛门生小虫，数十为群，或数百围如鬼灯状，痛痒难堪的，至弱冠多发劳瘵。
龟胸名恐不确，当称鸡胸似是。盖鸡胸病证在幼稚为疳，在少壮为痫也。
婴儿生七八月无病，至九十月渐肌肉肥胖，时时发热，如外感，或者如疟，吐乳青便，顶颅光莹，囟门或者填满，或者凹陷，睡中微抽的，将发阴痫的征兆。庸医不知道，认为胎肥，可笑。
儿四五岁，鼻衄血月一次或二三次，每次五六勺，多至数合，其血黯紫而稠粘，或者鲜红而稀薄。当其发作，必气逆面赤，手足微冷，消谷善饥，大便秘，小便数也。此证有乳癖腹痛后发的，有痘后发的，《千金》竹茹汤方中去芍药、人参、术桂，加麦门冬、黄芩、栀子、升麻
Background Information:
Book: Xianzhe Yihua (Conversations of Ancient Sages on Medicine)
Chapter: Gaoduan Zhiyuan (Part 1/2)
Category: Medical Discourse
Translation:
Zhiyuan, whose given name was Jingxuan and courtesy name was Zishun, belonged to the Gaoduan clan. During the Wenhua and Fangzheng eras, he gained fame in the capital for his medical skills. His benevolence and relief efforts benefited people of his time. After retiring from official duties, he lived in seclusion at Yingfeng, enjoying a leisurely life and self-cultivation, passing away at the age of seventy-three. Descending from renowned physicians such as Fengting, Taizhou, and Dongguo, Zhiyuan integrated various medical techniques with great acumen. His works, including *Yipu* (Medical Canon), *Fangpu* (Prescription Canon), *Yaopu* (Medicine Canon), and *Renzheng Lu* (Record of Syndrome Differentiation), offer a glimpse into his expertise. Herein, excerpts are recorded for reflection and enlightenment. Others such as Sanjiao, Xiaolin Zhuzhong, and Youchi also enjoyed successive reputations, but details remain unknown to me; thus, I hope to supplement them another day.
Diagnosis involves four causes, six syndromes, twelve signs, three examinations, and seven inspections. The four causes refer to external causes, internal causes, separate internal-external causes, and combined internal-external causes. The six syndromes refer to initial, middle, terminal, favorable, dangerous, and adverse stages. The twelve signs include cold, heat, deficiency, excess, superficial, deep, slow, urgent, stable, intermittent, normal, and variable conditions. The three examinations consist of pulse taking, abdominal palpation, and assessment of constitutional endowment. The seven inspections involve inquiring about the origin, seeking symptoms, observing complexion, viewing body shape, listening to voice, smelling odor, and careful study. These five methods comprising thirty-two rules are legacies of ancient Hehan sages and have been verified by our school. Those who carefully diagnose disease origins and syndromes must thoroughly investigate these principles.
In the early stage of epidemic febrile diseases (Wenyi), if appetite remains unchanged, taste is normal, spirit is clear, and daily activities are unaltered, fever will likely resolve. If appetite decreases or ceases when food is about to be taken, leading to weakness of Yuan Qi (Vital Energy), this occurs occasionally and should not be confused with mild epidemics where appetite remains good. For epidemics from onset to fever resolution, if food intake is poor, there is no need for excessive worry.
If a person suddenly faints and loses consciousness, then wakes with mental confusion, weak legs unable to stand, followed by burning body heat, dry mouth and tongue, frequent delirium, speech errors, spontaneous sweating, severe phlegm-wheezing, and irritability resembling stroke with hemiplegia, or accompanied by diarrhea/vomiting, hiccups, or slightly cold limbs, treating it as wind-stroke is an error. This results from severe epidemic heat transmitting directly inward, causing Yuan Qi depletion. It commonly affects those with weak constitutions and the elderly. Use Chaihu Runzao Tang (Bupleurum Moistening-Dryness Decoction) or Chaihu Gualou Tang (Bupleurum Trichosanthes Decoction). For phlegm-wheezing, Loubei Yangrong Tang (Trichosanthes & Fritillaria Nourishing-Nutrient Decoction) is suitable, though often incurable.
If epidemic disease lingers unresolved or pathogenic factors sink, suddenly transforming into Hongkong Jiao (Japanese Foot Disease / Beriberi), it is a critical sign.
If fingers twitch slightly at the onset of an epidemic, epilepsy may follow, which is difficult to treat.
After recovery from Cold Damage (Shanghan), epidemics, malaria-dysentery, or cholera, Hongkong Jiao may occur, or unresolved illness may transform into it. Unaware physicians mistakenly treat it as post-illness water qi, leading to death from upward rushing affecting the heart. Caution is required.
Postpartum Hongkong Jiao presents with numbness, bi-syndrome, weakness in limbs, difficulty moving, mental restlessness and palpitations, insensitivity in the abdomen, constant bodily heat, generalized or slight swelling, obesity/distension, tense sinews, emaciated/tense sinews, urinary retention, and a tight, forceful pulse. Use Xijiao Mahuang Tang (Rhinoceros Horn & Ephedra Decoction). Mistaking headache, rushing qi, and scant lochia for blood-qiu disorders and using blood-regulating agents is incorrect.
Wind-swelling (Fengzhong) manifests behind ears/neck (upper), chest/shoulders/back (middle), or thighs/shins (lower). Flowing accumulation swelling resembles carbuncles, being either congested or diffuse, painful or painless, resolving or suppurating. Initial signs include aversion to cold, high fever, headache, and body ache (exterior signs). Swelling behind ears/neck ranges from size of Luan seeds to pears. With exterior signs, use Jingjie Baidu San (Schizonepeta & Toxin-Resolving Powder).
Initial wind-swelling, if not distinguished from wind-cold or seasonal pathogens, may appear after exterior signs resolve, during exterior signs with swelling and heat resolution, with periodic chills/fever like malaria, continuous fever resembling warm diseases, or solely as swelling without exterior signs.
For measles, spontaneous sweating at onset indicates pathogen release via sweat. Vomiting indicates release via upper jiao. Diarrhea/vomiting indicates release via upper/lower jiao. Epistaxis indicates release via blood. These are auspicious signs; do not hastily use antiperspirants or hemostatics. Smooth eruption leads to natural recovery.
At measles onset, use Detoxifying, Shengma, Gegen, Muscle-Releasing, Yuebi, Lianqiao, or Liange decoctions. Failure to erupt is due to epidemic qi constraining toxin; use Qiyun Tang (Uncover Accumulation Decoction) to disperse epidemic qi for eruption. (Note: Qiyun Tang is a family formula of Gaoduan, containing Chaihu, Huangqin, Houpo, Banxia, Cao Guo, Zhishi, Gancao, Shengjiang—eight herbs, a variation of Jiawei Qingpi Tang.)
After eruption, if color is cinnabar-like but dull, spots are uneven/muddy, base pale red/dark, with fever/thirst, red eye vessels, bad breath, dry/cracked lips/tongue, restlessness, scant dark urine, and constipation, this is internal latent heat-toxin scorching blood. Use Liangxue Gongdu Yin (Cool-Blood Attack-Toxin Drink) with Xijiao and Shigao, or Dusheng San/Zixue. If spots are scorched purple/red macules with high fever, intense thirst, dark/scanty urine, hard stool, foul breath, mania/delirium, and irritability, use Yujin San. Sleep after administration brings mental clarity.
[Absent character, likely referring to 'Jia' or mass] disease occurs in the epigastric/hypochondriac region (upper), above umbilicus (middle), or lower abdomen (lower). It may surface or sink, support or invade hypochondria, be round/oval/flat/protruding, large like fists/turtles, small like eggplants/pears, hard as stone, soft as flesh, or flaccid as cotton. It may pull shoulders/back, cause spinal stiffness, pain or no pain, lower abdominal weakness, or sensation of narrowness. Pulse is typically deep/slow. In lower abdomen, starts small (walnut/egg), grows large over time, becoming round like pregnancy or squatting. Large masses fill abdomen like pumpkins, central or lateral, floating or fixed upon pressure. Painless or mildly painful, menstruation regular or heavy, mass expands. Eating/talking normal, only hindered when bending. Named Changtan (Intestinal Polyp/Mass). Difficult to cure, but not fatal; may shrink over years. Early use of Tongqi Songzhi agents (Qi-moving, stagnation-relieving) like Wuling Tongqi San may prevent it.
Jielao and Huan [missing char] Er Tang treat precursors of consumptive disease. Add Renshen (Ginseng) for weak abdomen. Add Beimu, Sangbaipi for mild cough. Add Digupi for deep heat. (Zhiyuan’s verified formulas, ancient or folk, constitute one-quarter of his practice, e.g., Huan [missing] Tang, Runfei Tang, Jiawei Chaihu Tang, often effective.)
When hernia heat is severe, causing delirium, thirst, yellow/white tongue coating, dysentery-like stool, lower abdominal cramping, unbearable lumbar/gluteal pressure, use Rongshan San. For severe heaviness/bearing-down, add Dahuang. Hernia without trigger, sudden hard lower abdominal pain radiating to hypochondrium, shortness of breath, intolerance to touch, agitation, fever resembling warm disease, thirst, dysuria, constipation, vomiting, hiccup, rising from lower abdomen to heart or pulling testicle, inability to lie down, abdominal distension with drum-like sound, is named Chongshen (Rushing Hernia). Mostly heat-type; use Rongshan Jada Huang Tang.
Neck tubercles in infants/children are俗称 as precursors of tuberculosis (Laobing). Not always true, but possible. (Note: *Jinkui Yaolue* states intestinal rumbling, machete-neck nodes indicate consumption. Neck nodes were considered a sign of consumption.)
Initial consumptive disease (Xulao) presents with abdominal fullness/hardness/pain, radiation to lower abdomen/cough, night sweats, low-grade fever, postprandial bloating, anorexia, frequent diarrhea (4-5 times/day), passage of intestinal mucus, relief after defecation, worsening if not, shortness of breath, agitation, prominent neck veins, dry throat/vomiting urge, slight limb edema with full dorsum pedis, throat noise, nasal flaring, unbearable abdominal pain, fatigue. Our school calls this Zhangfu Lao (Abdominal Distension Consumption). Pre-existing masses turning into consumption are often incurable. If Chai Ping Tang or Chaihu Binglang Tang hardens stool, reduces distension, stops pain/fever, it is a good sign. This is an adverse sign in consumption; misdiagnosing as simple distension is a major error.
Cold Damage with Guizhi syndrome plus vomiting is often due to retained fluids rejecting mild pathogens. Treating fluid retention resolves pathogen; thus, use Hexie Tang (Harmonizing Decoction) instead of Guizhi Tang.
Adding Qi-regulating herbs to diaphoretic agents accelerates efficacy by unblocking airways and expelling pathogens. Exception: severe pathogens. (My father added Gegen, Qianghuo, Jiegeng to Erchen Tang for mild wind-cold, following this principle. Note: During General Toyoda’s Korean campaign, many suffered exogenous pathogens; Bu Huan Jin Zhengqi San failed. An old physician in Oni General’s unit used Xiangsu San with immediate effect. Reason: Long campaigns cause Qi stagnation; Qi-agents are necessary. Kitayama Juian noted Xiangsu San treats colds, Qi stagnation headache/fullness, and foot disease, but its food-toxin resolving power is overlooked. Refer to this section.)
Warm disease with complete interior signs but slippery white tongue coating suggests Zangjie (Organ Knotting); do not miss the chance to purge. Verify other signs before purging. For chronic constipation patients, sudden slippery/watery stool in warm disease is not due to stomach deficiency/pathogen aggression. Delayed purging consumes Stomach Qi irreparably.
During hot baths, body feeling bound or poured with cold water indicates heat in muscle/surface.
*Qianjin Fang* considers floating pulse exterior and sunken pulse interior, a standard for physicians. Practically, floating pulse indicates dispersion/depletion, sunken pulse indicates closure/constriction; both can be Yin or Yang, so they cannot definitively determine exterior/interior.
Summer enuresis due to summer-heat uses Baihu Jia Renshen Tang. (Note: Some argue "enuresis" in Three Yang Combined Disease belongs under "delirium after sweating." Plausible, but real cases exist; verify clinically.)
Shoulder/back heaviness like 1000 jin spreading to whole body, followed by cold sweat, severe palpitations/agitation, then sudden relief, indicates impending stroke or Zhiyin (Supporting Fluid).
Wind disease coma recurring quickly is difficult to treat.
Post-stroke recovery with shoulder joint separation/dislocation is difficult; minor separation may heal. Hongkong Jiao without limb numbness/weakness/swelling/spasm, but with subcardiac urgency, lower abdominal insensitivity, normal appetite, postprandial shortness of breath, relieved lying down, upper body full/lower body thin, indicates upward rushing; do not ignore.
Dry Hongkong Jiao with hoarse voice/phlegm obstruction is often fatal.
Zhiyin, Hongkong Jiao, and Postpartum Blood-Qi diseases share similar symptoms but different origins; distinguish by pulse. Large pulse, empty on pressure = Zhiyin. Surging-rapid, tight-forceful on pressure = Hongkong Jiao. Weak-rapid, intermittent on pressure = Postpartum Blood-Qi. (Note: These three differ significantly; examine carefully.)
Lung萎 (Feiwei) with copious frothy sputum suddenly bleeding and fever is a bad omen.
Persistent cough with blood-streaked sputum or petechiae indicates Lung damage; seemingly mild externally but difficult to treat. I formulated Baiji Tang (Bletilla Decoction): Jiegeng Tang plus Baiji, Sangbaipi.
Consumptive hemoptysis varies: blood threads in sputum, or granules (bean-sized). Even minor bleeding must not be ignored.
Long-term cough with blood threads/petechiae indicates Lung damage; minor other symptoms still lead to incurability. Use Baiji Tang early. "Non-eating disease" (Bushi Bing) corresponds to Shenxian Lao in *Yiji*. Common in women, rare in men. Craving fried snacks/beans, fruits, raw vegetables, kelp/seaweed. Severe cases fast on grains, drink only water, yet muscles remain moist, activity normal, urination normal, constipation, dry mouth/thirst, lasting over a year. Originates from Qi stagnation; use Qi-regulating agents, not tonics.
Sudden decrease in appetite without cause signals major illness; cultivate health. Delay makes treatment futile. Acute decrease is treatable; gradual is difficult. Shenxian Lao differs despite anorexia.
Asthma with rapid pulse indicating Yin deficiency/Fire hyperactivity uses Ziyin Jianghuo Tang. Interior excess, constipation, forceful pulse uses Chengqi Tang.
Childhood asthma cured later may develop epilepsy, Xin Feng (Heart Wind), or seizure disorders due to congenital residual toxins; difficult to treat.
Childhood asthma treatment may transform into epilepsy, mania, Xin Feng, or vice versa. Adult-onset of these five diseases also stems from congenital toxins, differing only in Qi timing. Our school calls this Taibing (Fetal Disease), originating from *Suwen*.
Wind-phlegm patients with periodic fever/chills/headache/body ache, stiff shoulders/back, sore throat suffer from phlegm, not colds; commonly called Tan Feng (Phlegm Wind).
Chest Bi pain in skin/flesh is a bad omen.
Back pain (left/right) worsening with movement, sudden relief, often transforms into chest pain resembling Chest Bi but caused by sinew twisting. Causes shortness of breath, mild dysphagia. Pain differs from Chest Bi's penetrating pain; use Guixin San from *Beishi Fang*.
Hiccups unresponsive to hot herbs indicate constrained heat; use Xiexin Tang or Mafei Tang for quick recovery. (Note: *Wanbing Huichun* uses Huanglian Jiedu Tang/Baihu Tang for Cold Damage heat. Misuse of Ginger/Cinnamon aggravates fire/phlegm causing hiccups; same principle.)
Bitter/sour/astringent taste predicts Yige (Dysphagia); bitter-only is easier to treat.
Trauma with unresolved blood stasis causing late-onset shortness of breath, subcardiac rushing, coma, delirium, or amnesia is Blood Stasis mimicking wind.
Generalized edema with wasted/dry hands is incurable.
Female limb numbness often due to emotional stagnation/blocking meridians. Use Zhengqi Tianxiang Tang, or Xiangsu San + Erchen Tang + Wuyao.
Chronic female depression with vaginal pain/itching, discharge, poor appetite, fatigue uses Jiawei Guipi Tang. Heart blood deficiency leads to palpitations; use Siwu, Bazhen, Shibu, Renshen, Yangrong decoctions plus Maidong, Suanzaoren.
Changfeng (Intestinal Wind) usually lacks shortness of breath/tinnitus but may have dizziness.
Excess-type dizziness uses Fangfeng Tongsheng San plus Juhua.
Spontaneous dream vagueness, speech errors, hand tremors, flushed face/ears, laughter/grasping gestures, staring, then sudden clarity in robust individuals with dietary/emotional issues and labor fatigue is Xinhuang (Heart Palpitation/Stagnation). Untreated leads to wind-epilepsy. Start with Mituseng Wan, then Qingshen Tang or modified Qingshen Tang.
Rain-induced back pain uses Shen Shi Tang or Chushi Tang.
Sudden persistent night sweats with normal diet/activity/stool, scant urine, indicates water fluid seeping pores. Promote urination early with Fuling Gancao Tang; avoid astringents. If urination fails and sweating stops, edema/diarrhea may follow.
Tinnitus hearing only bells/clappers, losing other sounds, indicates impending deafness.
Epilepsy with foot/knee pain differs from Lijie (Joint Bi).
Anal worms in 10-year-olds, clustering like lanterns, causing itching, predict tuberculosis in young adulthood.
"Crane Chest" is likely "Chicken Chest." In children, it relates to Gan syndrome; in youth, epilepsy.
Infants healthy at 7-8 months gaining weight, fever (like cold/malaria), green vomit/stool, shiny scalp, fontanelle full/sunken, sleep twitching, indicate impending Yin Epilepsy. Misdiagnosed as fetal fat by quacks.
Children aged 4-5 with monthly epistaxis (5-6 spoons to cups), dark/thick or bright/thin blood, accompanied by qi reversal/red face, cold extremities, hunger, constipation, frequent urination. May follow breast lumps/abdominal pain or chickenpox. Modify *Qianjin* Zhuru Tang: remove Shaoyao, Renshen, Baizhu, Rougui; add Maidong, Huangqin, Zhizi, Shengma.