效。(竹茹、甘草、芎 、黄芩、当归、麦门冬、栀子、升麻、黄 、上九味加茜根佳。)
百会边时时如有物冲，或时痛，或泪管无故而喷出者，是将发脑风候。
结毒有胎霉二因，而因霉者十之八，胎仅居其二。其状多属冷毒，而属热者甚少。
露败疮与漏疮同，义通诸疮而言，非一病也。但彼则漏泄，此则闭结，虽其状异，至其
不痊一也。
霉毒有冷热之分，不可不详。冷毒尤少，而热毒常多。冷毒属气而痊迟，热毒属血而痊
速。
冷毒轻缓似易，热毒剧猛似险。又冷毒面色皓白如常，热毒面色惨黯隐显不定。冷毒生疮多
年不痊，而其势不剧甚，热毒则生疮浸淫为激发，是为辨。世医不知，一概治之，误人最伙
。(拙轩曰∶梅毒分冷热，翁之创见，非经历深者不能也。)
流注毒稠脓渐化为稀水者，非佳候。若脓止唯鲜血淋漓者，虽能食神爽，死在近，不可
轻忽。此与产后脱血其候同也。(败液流注往往发此证，最为危急候。)
桂山先生着书之富，从前医家无比，皆医林鸿宝，一日不可少，犹布帛菽粟。而治疗之
盛，年不下七八百人。是以一匕之验，半句之话，亦可以范后生矣。
小野氏乃政年十八，妊娠弥月，胎水渐盛，遍身洪肿，下体尤甚，口舌生疮烂坏，不能
啖盐
味，日啜稀粥仅一二碗，小便赤涩，大便隔日一解，脉滑数有力。医以为胃虚不能摄水，与
参术等药，势殆危剧，遽邀予理之。予曰∶胎水挟湿热者，非胃虚也。投以猪苓汤加车前子
、黄连、栀子，盖车前子一名苤苡，不止利小便。亦取毛诗云，宜怀妊之意，服五六日，逐
渐小水快利，肿胀稍散，口中亦和，饮啖复常。因改
用紫苏和气饮加白术、黄芩。至月尽而诞，母子两全矣。
御药局小吏儿生五个月，吐乳日六七次，无他证，惟面色青白，似稍疲倦。父母忧之，
请理
于予。予曰∶此责在小方脉，敢辞焉。渠曰∶凡小方理吐乳，非钱氏白术散、香砂六君子汤
，则凉膈散、紫圆之类，其变慢脾者，比比皆是，愿君别为处置，以救豚犬命也。恳请不已
，予因制一方以与之。半夏为君，茯苓为臣，藿香、伏龙肝为佐，
丁香为使，生姜为引，每帖一钱，水煎，别以养正丹为散，以挖耳头挑散
子入口中两麻子许，以前药汁送下，日五次，不浃旬而吐止神色复。故此予常用理翻胃方，
借以疗吐乳未足以为奇。而世之哑科徒守常套，而不知此等策，听其夭殇，悲夫!
一商家仆年二十岁，患脓淋数日，时时发微寒热，饮食少进。诊之，脉沉小而数，腹中
无病
，第似神色不太乐者。予以为肝经湿热，与龙胆泻肝汤。后十余日忽走使曰∶下血数升，命
在须臾。余仓皇往诊，仰卧蓐，气息绵 ，六脉洪数而虚，急灌独参汤，下咽即吐，寻之干
呕，额汗淋漓苦闷，吐蛔七条，试作小半夏加茯苓乌梅蜀椒汤与之，呕逆益甚。余沈思谓孙
思邈以单甘草止吐，今用之蛔必安，因如法服之，吐忽止，气息稍平。时看护者将更蓐，
除污 ，披衣视下体，阴囊破坏，有孔如剜，双卵坠在蓐，其大如鸡蛋而稍扁，色白而红缕
缠绕，众惊愕报予。予曰∶昔江篁南以阴囊破裂为千古稀见，况阴丸脱落者，可谓奇中之奇
矣。虽然，人有阉，豕有 ，此皆割势而犹能生。此人霉毒结于阴囊，故有此变，与坏鼻蜡
烛疳亦同，调护得宜，当不死，后调理果愈。
香港脚所因，有湿邪中足，壅塞经脉而致者，有肾气不足，饮水失道而致者，有膏粱过度
，脾
胃湿郁而致者。故预防之法，忌久坐阴湿地，或着滋湿衣，或冒雾而行，或步久雨霁后地气
蒸发之处，忌过食鱼乌饼粢一切浓味，忌大酒及醉睡，忌房事过度，及醉后入房，忌久坐久
立，及行步劳动俱失其常。慎此五者，则不止香港脚，亦诸病不生，久视之要诀也。
小儿吐乳虽数端，大要不过虚实二途。盖有胎元胃虚，不能消化乳汁以分布下部而吐者
，有
饮乳过食，结成癖积，拒格新乳而吐者，又有胎毒潜伏于肠胃之间，格拒乳汁，或两者相搏
，遂为顽涎，结聚胸膈而吐者。此证特多富贵，而贫贱最少。故治法宜清凉者多，而又有宜
温补者，又有不拘攻补从中治消痰化食降气杀虫以奏效者，当审其证而治之。
虚劳及极虚证。间有手指末节以下肿黑者，盖经脉不能盈四末，而瘀血败恶之所致，未
知前人言及否。
余曾闻之于太田隆元水肿并香港脚心下痞硬者，有辨冲心与痞之诀。其痞浮显，按之易知
者，无冲冲之患。其痞沉着，按之难认者，反生不测之变。宜潜心辨之。
久病不问何证，胁肋露歧骨如皱襞者，得生少。
仲景曰∶少阴病，脉微细，但欲寐，此少阴邪深入里，阳气衰竭故也。不止伤寒，诸久
病语话饮食之际亦眠者，死候也。
《证治要诀》曰∶诸中风忽吐出紫黑色者死。验之于诸病皆然，不止中风也。
医者对病患未诊之前，问其证候，胸中预拟其方。则诊毕后反失其真谛，宜虚心精诊，
而后熟虑下按矣。
俗所谓疝泻、疝痢、疝淋者，医书所谓气泻、气痢、气淋是也。
欲识古人临证施治之妙，莫如善读其治验。予将掇其精英，类为一书，而年老未果，哀
矣。(读前辈成案，可拓后学之心胸。扩群医之见解，第变通则在善学耳。)
月信痛，用桃核承气汤加附子效。盖本诸喻氏《寓意草》治伤寒后腰痛按。(一说云柳
所发明。)
木乃伊芳、血竭二味，等分为丸，能治干血劳。盖木乃伊芳活达瘀血，振兴真元故然。
半夏浓朴汤加浮石，以治梅核气奇效。
麻疹余热不解者，宜柴胡四物汤。( 庭曰∶疹后大抵主清润。故宜此方。)
诸大患卒发呕者，多不治，如香港脚冲心最然。
今时称淋者，多属霉毒，《疮疡经验全书》所谓内注下疳，(用小柴胡加龙胆、车前子
者。)
《证治要诀》所谓小便注杆甘疮类也，不可与古淋混治。(东郭亦有此说，而考证未确。)
一奴隶患手大指触物，则气宇郁塞，不可名状，诸治无效。余以为血气流注，与活络流
气饮速愈。
《痰火点雪》云∶劳疾左胁痛不能转身者，此乃肝叶已干，名为干血痛，肝经已绝，死
不治
。此说本于《直指方》，而其证今多有之。医误认为肝积，与熊胆等无寸效，宜矣。(山田
业广曰∶《素问·刺禁论》肝生于左，肺藏于右。其所谓生者，言生长其气于左。凡《素问》中言，生者皆同，言左者，
非言位置，肺藏于右亦然。验之于实际，病在左者，宜疏肝泻
肝，可以见也。)
《祝氏心医集》云∶疟疾每日如期而至，名曰疟信。此当原证发散，未可直攻，未可截
也。或前或后，此正气渐旺，邪将不容，名曰疟衰。方可截之试之甚理。
痢疾似虚而不虚，似实而不实者，用参归芍药汤，兼聂氏治痢第三方，米糊为丸，白汤
送下。
俗所传奇方者，多出于本草附方，不可不读。
水户候(文公)有疾，其初登圊大便不快下，胸满短气，如此两三日，或发或瘥，乃召余
诊之
。其脉滑数无根底，面色青惨，心下微满而拘急，腹里无动，脐下空软如绵，乃知其病上盛
下虚，非一日之故也。但侍臣视其起居如平，无能察知病情者。余出语之曰∶侯病虽似支饮
，实由中气虚耗，殆为危证，治法宜峻补方中加沉香，更进黑锡丹以回阳镇逆，犹恐不及也
。侍臣闻之，或惊惶，或疑惑，不知所为。明日诊之，间吐痰沫，其色茶褐色。厥明又诊之
，脉十动一止，因谓侍臣曰∶此证此脉，俱为脏气竭绝之候，恐有急变也，须灸天枢、气海
、三里、绝骨等以培下元。医不信，逡巡进降气之剂，而至日晡将登圊，短气息迫，卒然昏
倒，急使人召余，至则绝矣。余叹曰∶候之疾纵属不治，使侍臣早见其机，医察其微，则未
遽有今日之变也。
（竹茹、甘草、川芎、黄芩、当归、麦门冬、栀子、升麻、黄柏，以上九味药加入茜草根效果更佳。）
百会穴周围时常感觉有物上冲，或时而疼痛，或泪管无故喷出液体，这是脑风病即将发作的征兆。
梅毒（梅疮）的病因有胎传和霉毒两种，其中因霉毒感染的占十分之八，胎传的仅占十分之二。其症状多属于冷毒，属于热毒的很少。
露骨疮与漏疮相同，泛指各种疮疡而言，并非单一疾病。但漏疮是漏泄不止，此病则是闭塞结聚，虽然症状表现不同，但最终都不痊愈是一样的。
霉毒分为冷毒和热毒两类，不可不详细辨别。冷毒较少见，而热毒常见。冷毒病在气分，痊愈缓慢；热毒病在血分，痊愈迅速。
冷毒病情轻缓看似容易，热毒病情剧烈猛烈看似危险。另外，冷毒患者面色皓白如常，热毒患者面色惨暗且隐现不定。冷毒生疮多年不愈，但其势并不剧烈，热毒则生疮浸淫扩散为激发状态，这是辨别的要点。世俗医生不知此理，一概治疗，误人最多。（拙轩评论说：梅毒分冷热，这是翁氏的创见，不是经历深刻的人不能做到。）
流注毒症中，稠脓逐渐化为稀水的，不是好征兆。如果脓液停止流出，只有鲜血淋漓，虽然能进食、精神清爽，但死亡临近，不可轻视。这与产后脱血的证候相同。（败液流注往往引发此证，是最危急的证候。）
桂山先生著述丰富，从前医家无人能比，都是医学界的宝贵财富，一天也不能缺少，就像布帛菽粟一样重要。而他治疗的病人数量，每年不下七八百人。因此，他的一剂药见效，半句话的指导，都可以作为后生的典范。
小野氏乃政十八岁，怀孕满一个月时，胎水逐渐增多，全身严重浮肿，下肢尤其严重，口舌生疮溃烂，不能吃咸味食物，每天只喝一两碗稀粥，小便赤涩，大便隔日一次，脉象滑数有力。医生认为是胃虚不能摄水，给予人参、白术等药，病情几乎危重剧烈，于是急忙邀请我诊治。我说：“胎水挟带湿热，不是胃虚。”投以猪苓汤加车前子、黄连、栀子。因为车前子又名萹蓄，不仅有利小便的作用，也取自《诗经》“宜怀妊”的意思。服用五六日后，小便逐渐通畅，肿胀稍散，口中调和，饮食恢复正常。于是改用紫苏和气饮加白术、黄芩。到月底分娩，母子两全。
御药局小吏的儿子五个月大，每天吐奶六七次，没有其他症状，只是面色青白，似乎稍显疲倦。父母很担忧，请我诊治。我说：“这是儿科医生的职责，不敢推辞。”他说：“凡是小儿科治疗吐奶，不是用钱乙的白术散、香砂六君子汤，就是凉膈散、紫圆之类，变慢脾风的比比皆是，希望您另作处置，以救这孩子的命。”恳求不已，于是我配制一方给他。半夏为君药，茯苓为臣药，藿香、伏龙肝为佐药，丁香为使药，生姜为引药，每帖一钱，水煎，另外将养正丹研成散，用挖耳勺挑取像两粒芝麻大小的量放入口中，以前药汁送下，每天五次，不到十天吐止神色恢复。所以我常用治疗翻胃的方子，借此治疗吐奶并不奇怪。而世上的儿科医生只守常规套路，不知道这种策略，听任孩子夭折，可悲啊！
一个商人的仆人二十岁，患脓淋几天，时常发轻微寒热，饮食减少。诊察发现，脉沉小而数，腹中没有病变，只是神色不太快乐。我认为这是肝经湿热，给予龙胆泻肝汤。十多天后忽然派人来说：“下血几升，命在旦夕。”我仓皇前往诊察，患者仰卧在床上，气息微弱，六脉洪数而虚，急忙灌服独参汤，咽下即吐，接着干呕，额头出汗淋漓，痛苦闷乱，吐出蛔虫七条，尝试用小半夏加茯苓乌梅蜀椒汤给他，呕吐逆反更加严重。我沉思认为孙思邈用单味甘草止吐，现在用它蛔虫必安，于是依法服用，呕吐忽然停止，气息稍平。当时看护者准备更换床单，除去污秽，披衣查看下身，阴囊破裂，有个孔像挖空一样，双睾丸掉在床上，大小如鸡蛋且稍扁，色白而有红丝缠绕，众人惊愕报告给我。我说：“昔日江篁南认为阴囊破裂是千古稀见，何况睾丸脱落，可以说是奇中之奇了。虽然如此，人有阉割，猪有去势，这些都是割势后仍能生存。此人梅毒结于阴囊，所以有此变故，与坏鼻蜡烛疳相同，调护得当，应当不死，后来调理果然痊愈。”
香港脚（脚气病）的成因，有湿邪侵袭足部，壅塞经脉而致的；有肾气不足，饮水失道而致的；有膏粱过度，脾胃湿郁而致的。所以预防的方法，忌久坐阴湿地，或穿潮湿衣服，或冒雾行走，或步行长久雨后地气蒸发的地方；忌过食鱼、乌饼、粢等一切浓味食物；忌大量饮酒及醉酒后睡觉；忌房事过度，及醉后行房；忌久坐久立，及行走劳动都失去常态。谨慎这五点，那么不仅香港脚不生，其他病也不会生，这是长久健康的要诀。
小儿吐奶虽然有多种原因，大体不过虚实两条途径。大概有因胎元胃虚，不能消化乳汁以分布下部而吐的；有因饮乳过食，结成癖积，拒格新乳而吐的；又有因胎毒潜伏于肠胃之间，格拒乳汁，或两者相搏，遂成顽涎，结聚胸膈而吐的。此证特别多见于富贵人家，贫贱人家最少。所以治法宜清凉的多，但也有宜温补的，还有不拘泥于攻补，从中治疗消痰化食降气杀虫而奏效的，应当审察其证候而治疗。
虚劳及极度虚弱的证候。间或有手指末节以下肿黑的，这是因为经脉不能充盈四肢末端，而瘀血败恶所致，不知前人是否提及过。
我曾听太田隆元说过水肿并香港脚心下痞硬的鉴别方法，有辨别冲心和痞证的诀窍。其痞证浮显，按之容易感知的，没有冲冲上心的祸患。其痞证沉着，按之难以认出的，反而会产生不测的变故。应当潜心辨别。
久病不问什么证候，胁肋处肋骨显露如皱褶般的，得生的少。
张仲景说：“少阴病，脉微细，只想睡觉，这是少阴邪气深入里层，阳气衰竭的缘故。”不仅伤寒，诸久病在说话饮食时也睡觉的，是死候。
《证治要诀》说：“诸中风忽然吐出紫黑色血液的死。”验证于各种病都是这样，不只是中风。
医生面对病患在未诊察之前，询问其证候，心中预先拟定方剂。则诊察完毕后反而失去真谛，应该虚心精诊，然后熟虑再下诊断。
俗所谓疝泻、疝痢、疝淋，医书所谓气泻、气痢、气淋是同一回事。
想要了解古人临证施治的妙处，不如善于阅读他们的治疗验案。我将摘录其精华，分类编为一书，但因年老未能完成，悲哀啊！（读前辈成案，可以拓展后学的心胸，扩大众医的见解，只是变通在于善于学习罢了。）
月经痛，用桃核承气汤加附子有效。本自喻嘉言《寓意草》治疗伤寒后腰痛按压之法。（一说认为是柳宝诒发明。）
木乃伊芳（阿魏）、血竭两味药，等分为丸，能治疗干血劳。因为木乃伊芳能通达瘀血，振兴真元，所以如此。
麻疹余热不解的，宜用柴胡四物汤。（庭评论说：疹后大体主张清润。所以宜用此方。）
现今所称的淋证，多属于梅毒，《疮疡经验全书》所谓内注下疳（用小柴胡汤加龙胆草、车前子的）。《证治要诀》所谓小便注杆甘疮类也，不可与古淋混淆治疗。（东郭也有此说，但考证不确切。）
一个奴隶患手大拇指触物，则气宇郁塞，不可名状，各种治疗无效。我认为这是血气流注，给予活络流气饮迅速痊愈。
《痰火点雪》说：“劳疾左胁痛不能转身的，这是肝叶已干枯，名为干血痛，肝经已绝，死不治。”此说本于《直指方》，而其证现今多有发生。医生误认为是肝积，给予熊胆等药无寸效，理所当然。（山田业广说：《素问·刺禁论》说肝生于左，肺藏于右。所谓生，是说生长其气于左。凡《素问》中言生者皆同，言左者，非指位置，肺藏于右亦然。验证于实际，病在左者，宜疏肝泻肝，可以看出。）
《祝氏心医集》说：“疟疾每日如期而至，名叫疟信。这应当根据原证发散，不可直接攻伐，不可截断。或前或后，这是正气渐旺，邪气不容，名叫疟衰。方可截断试探，很有道理。”
痢疾似虚而不虚，似实而不实的，用参归芍药汤，兼用聂氏治痢第三方，米糊为丸，白开水送下。
俗所传奇方，多出于本草附方，不可不读。
水户侯（文公）有病，起初登厕所大便不畅，胸满短气，如此两三天，或发或愈，于是召我诊治。其脉滑数无根底，面色青惨，心下微满而拘急，腹里没有动气，脐下空软如棉，才知道病上是盛而下虚，不是一天的缘故。但侍臣看他的起居如平常，不能察觉病情。我出来对他们说：“侯的病虽似支饮，实由中气虚耗，大概是危证，治法宜峻补方中加沉香，更进黑锡丹以回阳镇逆，还恐怕来不及。”侍臣听了，有的惊惶，有的疑惑，不知所措。第二天诊察，间或吐痰沫，颜色茶褐色。第三天又诊察，脉十动一止，于是对侍臣说：“此证此脉，俱为脏气竭绝的征候，恐怕有急变，须灸天枢、气海、三里、绝骨等穴以培补下元。”医生不信，迟疑后进降气之剂，到了傍晚将要登厕所，短气息迫，突然昏倒，急忙派人召我，到了已经断气。我叹息说：“侯的病纵然属不治，假如侍臣早见其机，医生察其微，则未必有今日之变。”
(Efficiency. (Zhu Ru, Gan Cao, Xiong [Chuanxiong], Huang Qin, Dang Gui, Mai Men Dong, Zhi Zi, Sheng Ma, Huang Bo; the above nine herbs added with Qian Gen are better.)
At the periphery of Baihui acupoint, there is a constant sensation of something rushing upwards, or intermittent pain, or tears spurting from the tear ducts without cause. This is a sign that Nao Feng (Brain Wind) is about to manifest.
Mei Du (Syphilis) has two causes: congenital transmission and acquired infection (referred to as "mold toxin"). Acquired infections account for 80%, while congenital cases account for only 20%. The symptoms mostly belong to Cold Toxin, with very few belonging to Heat Toxin.
Lu Bai Chuang (Exposed Bone Ulcer) is synonymous with Lou Chuang (Fistula), referring generally to various sores rather than a single disease. However, Lou Chuang involves leakage, whereas this condition involves closure and obstruction. Although the manifestations differ, both ultimately fail to heal.
Mei Du is divided into Cold Toxin and Heat Toxin, which must be distinguished in detail. Cold Toxin is rare, while Heat Toxin is common. Cold Toxin affects the Qi level and heals slowly; Heat Toxin affects the Blood level and heals quickly.
Cold Toxin appears mild and easy, while Heat Toxin appears severe and dangerous. Furthermore, patients with Cold Toxin have a pale white complexion like normal, whereas those with Heat Toxin have a dull, dark complexion that fluctuates. Sores from Cold Toxin may persist for years without healing but are not intense; sores from Heat Toxin spread and exacerbate rapidly. This is the key to differentiation. Ignorant physicians treat all cases uniformly, causing the most harm. (Zhu Xuan commented: Dividing syphilis into cold and heat types is an innovative view by Mr. Weng, achievable only by those with profound experience.)
In Liu Zhu Du (Flowing Abscess Toxin), if thick pus gradually turns into thin fluid, it is not a favorable sign. If pus stops flowing but fresh blood drips continuously, even if the patient can eat and feels mentally clear, death is imminent. Do not neglect this. This presentation is identical to Chou Xue (Postpartum Hemorrhage). (Decayed fluid flowing often triggers this syndrome, which is the most critical condition.)
Mr. Guishan's literary output was unparalleled among previous physicians. His works are treasures of the medical field, indispensable as daily necessities like cloth and grain. He treated no fewer than 700 to 800 patients annually. Therefore, his effective prescriptions and insightful advice serve as models for younger generations.
Xiao Ye Shi Naizheng, aged eighteen, had been pregnant for one month when fetal fluids increased progressively, causing severe edema throughout the body, especially in the lower extremities. Mouth and tongue ulcers formed, rendering him unable to consume salty foods. He drank only one or two bowls of thin porridge daily. Urine was red and difficult to pass, and bowel movements occurred every other day. The pulse was slippery, rapid, and forceful. Physicians attributed this to Spleen/Stomach deficiency failing to control water and prescribed Ren Shen (Ginseng) and Bai Zhu (Atractylodes). The condition nearly became critical, so he urgently invited me to treat him. I said, "Fetal fluids carrying Damp-Heat are not due to Stomach deficiency." I administered Zhu Ling Tang (Polyporus Decoction) with Che Qian Zi (Plantago Seed), Huang Lian (Coptis Rhizome), and Zhi Zi (Gardenia Fruit). Che Qian Zi, also known as Pian Xi, not only promotes urination but also aligns with the poetic sentiment of "suitable for pregnancy" from the Book of Songs. After five to six days, urination became smooth, swelling subsided slightly, the mouth felt harmonious, and appetite returned. The prescription was then changed to Zi Su He Qi Yin (Perilla Harmonizing Qi Decoction) with Bai Zhu and Huang Qin. Delivery occurred at the end of the month, and both mother and child survived.
The son of a minor official in the Imperial Pharmacy vomited milk six to seven times daily at five months old, with no other symptoms, except for a bluish-white complexion and slight fatigue. His parents were worried and sought my treatment. I said, "This falls under the jurisdiction of pediatric specialists; how dare I decline?" He replied, "Pediatric treatments for vomiting milk usually involve Qian Yi's Bai Zhu San, Xiang Sha Liu Jun Zi Tang, Liang Ge San, or Zi Yuan. Cases transforming into Man Pi Feng (Slow Spleen Wind) are common. Please devise a different treatment to save this child's life." Upon persistent pleading, I formulated a prescription: Ban Xia (Pinellia Tuber) as Sovereign, Fu Ling (Poria) as Minister, Huo Xiang (Patchouli) and Fu Long Gan (Vermilion Dragon Liver) as Assistants, Ding Xiang (Clove) as Envoy, and Sheng Jiang (Fresh Ginger) as Guide. Each dose was one qian, decocted in water. Additionally, Yang Zheng Dan (Nourishing Righteousness Pill) was powdered. A quantity equivalent to two sesame seeds was placed in the mouth using an ear pick, washed down with the herbal liquid, five times daily. Within ten days, vomiting ceased, and color/spirit recovered. Thus, using formulas for Fan Wei (Regurgitation) to treat infant vomiting is not strange. It is tragic that contemporary pediatricians stick to routine protocols, unaware of such strategies, allowing children to die prematurely.
A merchant's servant, aged twenty, suffered from Nong Lin (Purulent Strangury) for several days, experiencing intermittent mild chills and fever, with reduced appetite. Pulse was deep, small, and rapid. Abdominal examination revealed no pathology, though the patient appeared somewhat depressed. I diagnosed Liver Meridian Damp-Heat and prescribed Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction). Ten days later, a messenger arrived hastily reporting massive hematochezia and imminent death. I rushed to examine him. He lay supine on the bed, breathing faintly. The six pulses were flooding, rapid, and empty. I urgently administered Du Shen Tang (Single Ginseng Decoction), but it was vomited immediately, followed by dry heaving, profuse forehead sweating, and distress. Seven roundworms were vomited. I attempted Xiao Ban Xia Jia Fu Ling Wu Mei Shu Zhu Tang (Minor Pinellia plus Poria, Sour Plum, and Sichuan Pepper Decoction), but vomiting worsened. Contemplating Sun Simiao's use of single Gan Cao (Licorice Root) to stop vomiting, I reasoned it would pacify the worms. Following this method, vomiting stopped, and breathing stabilized. While attendants were changing the sheets and cleaning up, they uncovered the lower body. The scrotum was ruptured with a hole as if gouged out; both testes had fallen onto the bed, size of chicken eggs, slightly flattened, white with red filaments缠绕. Everyone was shocked and reported to me. I said, "Jiang Huangnan once considered scrotal rupture a rarity in history. Testicular detachment is truly extraordinary. Although castrated humans and gelded pigs survive, this case resulted from Mei Du (Syphilis) condensing in the scrotum, similar to 'Bad Nose Candlestick Chan' (nasal destruction from syphilis). With proper care, he should survive." Subsequent management led to full recovery.
The etiology of Hong Jiao Jiao (Hong Kong Foot / Beriberi) includes: Damp-Evil invading the feet and obstructing meridians; Kidney Qi deficiency leading to improper fluid metabolism; or excessive rich food causing Spleen/Stomach Damp-Stagnation. Prevention requires avoiding sitting long in damp places, wearing wet clothes, walking in fog, or walking on ground after rain where vapor rises. Avoid overeating fish, dark cakes, and strong flavors. Avoid excessive alcohol, drunken sleep, excessive intercourse, and intercourse while drunk. Avoid prolonged sitting/standing and irregular physical labor. Observing these five points prevents not only Hong Jiao Jiao but also other diseases; it is the secret to longevity.
Infant vomiting milk has many causes but essentially falls into Deficiency and Excess categories. Causes include: Congenital Spleen/Stomach deficiency failing to digest/distribute milk; Overfeeding leading to accumulation rejecting new milk; or latent Fetal Toxin in intestines/stomach repelling milk, or fighting with milk to form stubborn phlegm accumulating in the chest/diaphragm. This condition is more common in wealthy families than poor ones. Treatments favor cooling/clearing, but warming/nourishing methods are also used. Some cases respond to middle-jiao regulation, phlegm resolution, food digestion, Qi descending, or parasite expulsion. Treatment must be based on syndrome differentiation.
In Xu Lao (Consumptive Disease) and extreme deficiency syndromes, blackening and swelling of the distal finger joints occasionally occur. This is caused by meridians failing to fill the extremities and stasis/dead blood. It is unknown if predecessors mentioned this.
I heard from Tai Tian Long Yuan regarding edema combined with Hong Jiao Jiao presenting with epigastric fullness/hardness. There is a key to distinguishing Chong Xin (Rushing to Heart) from Pi (Glomus). Floating, easily palpable glomus carries no risk of rushing to the heart. Deep, hard-to-palpate glomus poses unpredictable dangers. Careful differentiation is required.
In chronic illness, regardless of syndrome, if ribs protrude like wrinkles, survival is rare.
Zhang Zhongjing stated: "Shaoyin disease, with fine and weak pulse, and desire to sleep, indicates Shaoyin pathogen entering deeply interior, with Yang Qi exhaustion." This applies not only to Shang Han but also to any chronic illness where speech/eating is accompanied by drowsiness, indicating a fatal prognosis.
Zheng Zhi Yao Jue states: "Sudden vomiting of purple-black blood in stroke indicates death." This verification applies to all diseases, not just stroke.
Before examining a patient, if a physician pre-determines a formula based on inquiry, the actual diagnosis may lose its essence. One must examine with an open mind, then deliberate before prescribing.
Colloquial terms Shan Xie (Hernia Diarrhea), Shan Li (Hernia Dysentery), Shan Lin (Hernia Strangury) correspond to medical texts' Qi Xie, Qi Li, Qi Lin.
To understand the subtleties of ancient clinical practice, nothing beats studying their verified cases. I intended to compile their essence into a book, but old age prevented completion. Sad! (Reading senior physicians' cases expands students' minds and broadens practitioners' perspectives; flexibility depends on good learning.)
Dysmenorrhea responds well to Tao He Cheng Qi Tang (Peach Kernel Draining the Epigastrium Decoction) with Fu Zi (Aconite Root). This derives from Yu Jia Yan's *Yi Yu Cao* treating lumbar pain after Shang Han. (Another theory attributes this to Liu Bao Yi.)
Mu Nai Yi Fang (Styrax Resin) and Xue Jie (Dragon's Blood), equal parts made into pills, treat Gan Xue Lao (Dry Blood Consumption). Styrax resolves stasis and revitalizes true Yuan, hence its efficacy.
Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) with Hai Fu Shi (Sea Float Stone) shows miraculous effects for Mei He Qi (Plum-Pit Qi).
For lingering residual heat after Meisha (Chickenpox/Rubella), Chai Hu Si Wu Tang (Bupleurum Four Substance Decoction) is appropriate. (Ting commented: Post-rash treatment generally emphasizes clearing and moistening, hence this formula.)
Sudden vomiting in major acute illnesses is often untreatable, typical of Hong Jiao Jiao Chong Xin (Beriberi Rushing to Heart).
Contemporary "Lin" (Strangury) often refers to Syphilis. As described in *Chuang Yang Jing Quan Shu* as Nei Zhu Xia Gai (Internal Injection of Chancre), treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Long Dan Cao (Gentian Root) and Che Qian Zi. Also referenced in *Zheng Zhi Yao Jue* as Xiao Bian Zhu Gan Chuang Lei. Do not confuse with ancient Lin syndromes. (Dong Guo held this view but lacked rigorous verification.)
A slave suffered indescribable chest oppression upon touching his thumb, unresponsive to various treatments. I diagnosed Blood/Qi Flow Obstruction and prescribed Huo Luo Liu Qi Yin (Unblocking Meridians Circulating Qi Decoction), resulting in rapid cure.
*Tan Huo Dian Xue* states: "Labor disease with left hypochondriac pain preventing turning is Gan Ye Yi Gan (Liver Leaf Dryness), named Gan Xue Tong (Dry Blood Pain). Liver Meridian is exhausted; death is inevitable." This originates from *Zhi Zhi Fang*, and such cases are common today. Misdiagnosing as Gan Ji (Liver Accumulation) and treating with Xiong Dan (Bear Gallbladder) yields no effect, as expected. (Shan Tian Ye Guang noted: *Su Wen · Ci Jin Lun* says 'Liver grows on the left, Lung stores on the right.' 'Grows' means generating Qi on the left. 'Left' does not denote anatomical position. Clinical evidence supports soothing/draining Liver for left-sided pathology.)
*Zhu Shi Xin Yi Ji* states: "Malaria arriving daily on schedule is called Miao Xin. It should be dispersed according to the primary syndrome; direct attack or interception is premature. Variations in timing indicate rising Zheng Qi rejecting Xie Qi, called Miao Shuai. Interception can then be tested. This reasoning is sound."
For Dysentery appearing deficient yet not truly deficient, or excess yet not truly excess, use Shen Gui Shao Yao Tang (Ginseng, Angelica, and Peony Decoction) combined with Nie Shi's Third Dysentery Formula, made into pills with rice paste, taken with warm water.
Legendary folk remedies often originate from Ben Cao appendices; these should be studied.
Lord Mito (Wen Gong) fell ill. Initially, he experienced difficulty defecating, chest fullness, and shortness of breath for two to three days, fluctuating in severity. I was summoned. Pulse was slippery, rapid, and rootless. Complexion was dark blue-green. Epigastrium was slightly full and tense. Abdomen showed no movement. Umbilical region was soft like cotton. I determined the pathology was Upper Excess and Lower Deficiency, developing over time. Attendants observed normal activity and missed the severity. I told them: "Though resembling Zhi Yin (Fluid Retention), this is actually Middle Qi exhaustion, a critical condition. Treatment requires vigorous tonification with Chen Xiang (Agarwood) added, followed by Hei Xi Dan (Black Tin Pill) to restore Yang and anchor rebellious Qi. Even this may be insufficient." Attendants were panicked or skeptical. Next day, tea-brown sputum was vomited intermittently. On the third day, pulse showed one stop per ten beats. I warned: "This syndrome and pulse indicate organ Qi exhaustion; acute change is feared. Moxibustion on Tianshu, Qihai, Zusanli, and Jiexu is needed to nourish Lower Yuan." Physicians disagreed, hesitated, and administered Qi-descending agents. By dusk, approaching defecation, he gasped and fainted suddenly. I was summoned but arrived too late. I sighed: "Even if untreatable, earlier recognition by attendants and subtle observation by physicians might have prevented this outcome."