钱、制附子二钱，浓煎半碗，人参一两，煎至半钟冲服，口渴另用熟地二两、生麦冬五
钱、人参八钱，浓汁碗许代茶饮之，三四剂后，头颅溃汗如雨者渐收，手足心干燥如火
者渐润而温和，舌黑渐减，神色渐清，饮食渐思，热退嗽止，其后晨用生脉饮送服十补
丸四五钱，午后以归脾加减煎膏成丸如弹子大，圆眼汤化服一丸，不一月而痊愈，精神
更胜。
部主政山西李老先生，为人端方仁浓，与余相契十有年矣。癸亥入都，先生足病，
疼痛不堪，步履久废，医用香港脚祛风燥湿之药，久服不效，饮食不甘，精神益疲，望余
久矣。一入都门，即来延视，两寸洪大而数，两关便弱，两尺更微。余曰∶人但知洪
数为实热，而不知六脉洪数有力为实热是矣。若洪数而止见于寸，则上热中虚，而下
寒也。大而数者，阳越于外也。细而数者，阴竭于内也。皆非实热，尽当虚论，今老先
生之脉，孤阳浮越在上，而里实无阳也。夫阳气者，《经》所谓∶若天与日也。阳气不
到之所。如天日照临不及之地，则阴寒凝泣
为病。凡阴必从阳长，故气病而血亦病焉。再用驱风燥湿，有是病则病当之，无是病则
气血更受伤矣。脾主四肢，痿取阳明，肝肾筋骨，数脏并宜重焉。乃以前方加生杜仲三
钱，杜仲古名思仙术，盐酒炒则入内而走腰肾，酒炒则走周身筋骨，且能去风，不制则
下达，其性能令筋骨相着也。凡初病轻病，或一脏或一腑受伤，久病重病必脏腑牵连俱
困，脏为阴，可胜纯阳之药，腑为阳，必加阴药制其潜热，务使五脏调和，互为灌溉，
脏脏气血自生，脏脏有邪难匿，根本之处得力，枝叶之所自荣，邪不待攻而解矣。先生
大悦，十余则后，自见康胜，其后晨以生脉饮送八味加鹿茸、牛膝、杜仲之丸药五钱，
午后以人参、炙黄 、枣仁、当归、炒白芍、炒白术、茯苓、生杜仲、续断、牛膝，
薄桂，大枣煎服，调理月余，精神健旺，步禾如初，适余南回，先生送我而言曰∶在
生一日，感激一日也。
刑部主政姚老先生，夏月钦命赴审河南，根据限往返，劳顿太甚，回京正当衙门办
事，忽然手足麻木不举，乃回私宅，招一医诊视曰∶此中暑也。以香需饮服之，觉甚不
安，乃延余治，按其脉洪大而空，此血脱而非暑伤气之脉也。不敢直指其非，但云∶恐
将来脚上又中暑矣。先生未达其意，余回寓少顷，果足亦麻木，不能举动，先生始悟，
遣使招余求治，此时口 舌强，自汗诸症俱见矣。乃以前方加减分两，连服两剂，汗少
减而神始清，后以河间地黄饮子加减而愈。令弟中翰二先生，偶索余诊，两寸洪大倍
常，两尺微弱倍甚。如出两人之手。余曰∶先生无病而得此脉，诸宜慎之。先生曰∶脉
主将来何病？余曰∶恐亦类令兄先生之病，而害则过之。渠曰∶家兄中风之症，不为轻
矣。宁有更重于此者乎！抑愚弟兄或病各不同，而岂必具犯中风者乎！且家兄因无子
故，或者未能绝欲，弟则独宿旅邸多年，可以自信，倘病出意外，再求调治未晚也。余
见渠甚忽略，亦不复为进言，一月之后，无故卒倒，急遣招余。余曰∶形未病而脉先
病，根本萎之于中久矣。岂可救乎？力请视之，脱症具备，已不能药矣。次日而卒，令
兄先生尤以身命自重，弃官告假而归，后叩其故，大先生果因无子而多欲，二先生果绝
欲而日醉酒，可见酒色害人一也。
长儿之太翁，高年且患足疾初愈，适于途中遇雨，疾趋而回，未几身热自汗，头疼
咳嗽，继而吐血，饮食不思，精神野狼狈，延余诊视，两寸皆洪大而数，右关两尺甚微，
此劳伤中气，脾不能统血也。咳嗽者火烁于肺也。身热者元阳浮越也。自汗者，气虚不
能摄液也。头疼者，血虚火冒也。悉用前方熟地一两、炒麦冬四钱、炒白术二钱、牛膝
三钱、五味子一钱、制附子一钱二分，另煎人参冲服，数剂之后，咳嗽吐血俱止，身凉
进食而痊，后早晨生脉饮送加减肾气丸，午后以归脾汤，加减服之，精神如旧。
徐管朗先生夫人年七十余岁，忽患重疟，上则咳嗽吐血，下则泄泻，粒米不进，
人事不省，胸膈胀甚，脉则两寸细数，左关弦大，右关甚微，两尺重按不起，势甚危
笃，先生祷于关夫子前，得黄阁开时延故客之签，乃思十年前大病，余所治疗，因复来
招，按其脉知为阴虚内热，阳虚外寒，肝无血养而强，脾无气充而弱，血无所统而吐，
谷无所运而泻，气无所纳而胀，悉属本气为病，乃用前方冲参汤服，疟止神清，奈病患
自谓胸有停滞，人参补药，必不肯服，乃令管朗先生以八味丸，云消食丸进之，病患始
允，日以参汤送服，胸胀泄泻，吐血诸症余愈，饮食精神，俱倍于平日。
余侄孙年止三岁，身热咳嗽数日，适乡间痘疮盛行，因有近医以疏散风痰，兼行
托痘为治，至六七日后，热势更甚，干哕吐蛔，神昏气促，食乳即吐，目闭不语，面青
目直，哭无涕泪，乃来告急，余视之，此子先天不足，故面色 白皮细，初受外感虽
轻，而中气之虚已甚，复加疏散透托，元阳汤液皆两亡矣。乃用前方熟地五钱、炒麦冬
二钱、炒白术三钱、牛膝二钱、五味子四分、制附子八分，另煎人参二钱冲服，一剂
热减，而一眼一鼻少有涕泪，二剂之后，始能受乳，热更减，而涕泪俱有矣。三四剂
后，热退神爽，复以生脉饮，每早化服八味丸一钱二分，旬日而精神平复。
沈定老之孙媳，曾患久疟，已而成痞常发，胀痛不堪，久服顺气化痞而不效，今复
壮热咳嗽，胸次胀疼更甚，延余诊视，按其脉两寸独洪，余皆微弱，右关尺尤甚，乃知
土位无母，子母两虚，中空外浮之假象，投以前方一二剂，而胀痞倍加，余曰∶此药力
攻击，浊气解散而未降也，当再服之。复进二三剂，人参倍用，所谓少则壅滞，多则宣
通也。果数日后咳嗽身热俱退，饮食进而精神健旺，其两载之痞胀，一日化为正气而守
丹田，毫无形迹矣。
金绍老太夫人，脾肾素虚，因岁事积劳之后，忽眩晕不醒，妄有见闻，语言杂乱，
急求请治，诊其脉细数无伦，真阴真阳并亏已极。余曰∶乘此初起，即为挽回，勿少担
延，愈久愈虚愈脱，即用前方日进二剂，每剂人参二钱，日愈一日，不十日而全痊。
庠生徐山公，偶患似疟非疟，医以柴胡汤连进数剂之后，渐至不省人事，口噤僵
卧，渠家内外，俱以为断无生理矣。请余诊之，不过欲决其死期耳。余曰∶阳虚作寒，
阴虚作热，误为疟治而未绝，便非绝症也。急以前汤，每剂人参一两，煎汁冲服，三日
而苏，复重温补而痊愈。
翰院河南刘老先生令郎，乡试入都，长途冒暑，气已伤矣。到寓日夜课读，未几壮
热头疼，咳嗽干哕，日夜不寐，精神困顿，众皆以其先受暑气，继感风寒，与余商治，
按其脉两寸俱洪，两尺俱弱，右关沉取俱无，右尺倍弱于左，余思此犯无胃气之症
参。若不直入挽救无济也。理直温补脾肾二家，理中八味并不可少，奈主人以暑天热
病，断勿肯用，必欲另方乃服。余曰∶病家徒认候，医家必据脉，今令郎之脉候迥别，
脉为病患真源，候多病之假象，土为万物之母，故诸病无胃气则死，阳病见阴脉者死，
症已十分沉困，奚容再误于药，彼此勿听，坐视数日，病势益甚，身益野狼狈，复延余
商，按其脉仍故，但燥涩无力，较前过之，此久热阴阳愈伤矣。余复举前方为治，况此
即古方附子理中汤、去炮姜甘草，加熟地、炒麦冬、牛膝、五味子四味耳。何必虑之，
午后又服一剂，以八味去丹皮、泽泻，加牛膝、生麦冬、五味子三味冲参汤服，每剂人
参八钱，服后甚安，主人病患乃斗胆服之，数日之后，头疼身热咳嗽渐愈，而哕声间尚
有之，然仍脾胃脉不起，毫不思食也。余思身热头疼既退，火已藏舍矣。尚不喜食者，
未及补土之剂也。乃早晨以生脉饮送服八味之去丹皮、泽泻，加鹿茸、五味子之加减十
补丸四钱，晚用加减归脾汤去木香、甘草，加五味子、肉桂，一补先天，一补后天，渐
渐喜食，脉起而康强。先生乔梓始知从前之壮热头疼皆本气为病，全非外感也。深以为
喜。同时少宰彭老先生之三公郎亦患是病，身热两月，久服补中益气加减，升麻、柴
胡、陈皮、半夏已数十剂矣。殊不知地黄丸以降为升，盖浊阴下降，清阳自升，肾有补
无泻，故宜久服者也。补中汤以升为降，盖使清气上升，浊气降散，东垣为虚人发散而
设，故不宜久服者也。且时当夏月，天之阳气浮越地表，人之阳气浮越身表，况复犯阳
浮发热之病，又伤升浮阳气之药，以致汗多，久热不已，阴阳两亡，中宫元气，下焦
阳气大虚，《经》曰∶脉平阳秘，精神乃治，阴阳离决，精气乃绝，所以面青浮肿，肚腹
胀硬，心下痞隔，咳嗽咽痛，口多甜涎，壮热畏寒，五心燥热，日不干渴，足胫常冷，
脉则两寸乍洪乍数，两关无力，两尺更微，其右关右尺倍弱，乃系脾肾两亏，上实下
虚，外热内寒，真寒假热之症也。余早晨以生脉饮送服河车膏丸、十补丸四钱、午间食
前，以前方熟地一两二钱、炒麦冬三钱、炒白术四钱、牛膝二钱四分、五味子八分、制
附子一钱五分，另用人参一两，煎汁冲服，可喜两月不退之热，服此壮热渐减，旬余畏
寒身热全退，面肿肚胀全消，面青咽痛痊愈，饮食渐知香味矣。但小腹未能平复，继
进加减附子理中汤数剂，大便下如蟹沫而不臭，十余次，便时肛门自觉甚冷，岂非里无
阳气，以致阴寒久滞于中之验乎，自后小腹始软，六脉平和，此阳和冰解之象，乃佳兆
也。奈有一医从傍鼓惑，许以三剂痊愈，彭老先生喜闻其言而听之，复用发散消痰，如
苏叶、柴胡、腹皮、浓朴、陈皮、半夏之类，非补中益气加减，则六君子加减，以致
身热复发，汗出复多，烦渴减食，阴阳并竭，人生所仗之精气神，终被升柴陈半搬运
殆尽而后已，可惜余一月调养之苦心，去病十有其七，更可惜孝友性成，谦恭仁浓之佳
公子复被庸医数十剂之升柴，将生之气复虚，遂致不起，惜哉！
老友谢登之年七十余矣。偶于途中遇雨疾趋而归，继发疟疾甚危，遇发随必大便，
遇便随必昏晕欲绝，伊芳亲投以疏散，而势愈甚。余曰∶冒雨果受寒，而宜疏散矣。独不
思《经》曰∶惊而夺精，汗出于心，持重远行，汗出于肾，疾走恐惧，汗出于肝，摇体
劳苦，汗出于脾，五脏俱伤矣。凡入者为实，出者为虚，大便出而即昏晕，元气欲脱
矣，尚可以既散之微寒为重，而垂绝之无气为轻也。急以人参三钱、白术六钱、炮姜一
钱、五味子、炙甘草各一钱、制附子一钱二分，投服而愈。或曰∶愈则愈矣，但五味酸
敛，恐有余邪未尽也。嗟嗟，是尚以疟症为有迹之真邪，而未达阴阳虚极之变现，顾标
罔顾本之见也。且有附子通经达络之大功，虽有强邪，无地可匿，况更有炙草炮姜开发
之药，能不少佐敛阖，以为收摄元气之用耶。
立斋曰∶气血虚而变现诸症，莫可名状，故贵治者熟得气血虚实之情，阴阳变化
之用，脉气真假之征，则虽病状变现百出，总不外乎阴阳气血虚实中以尽之。至于诸疮
诸肿，感六腑者发于皮毛肌肉，感于五脏者发于经络骨髓，莫非阴阳气血相滞而生，气
血有余，则红肿高起而为阳毒，气血不足，则阴塌平陷而为阴毒。丹溪所谓阴滞于阳，
阳滞于阴，百病皆由于此，不止痈疽而已。《经》云∶邪之所凑，其正必虚，着而不去，
其病为实是也。本阴阳不知，气血涩滞，阳不足则寒湿凝泣，阴不足则火热沸腾，乃是
血为之浊，气为之乱，隧道阻滞，犹水流不污。今气血既凝而且郁，能不各随经络渗入
脉中，溢于脉外，腐溃成脓乎？名之曰∶毒者，气血不知之谓。如人之气不和平而有
毒性之类也。然大肿大毒，发于骨髓经络者，不于先天水火真阴阳求之，不能疗也。
若诸疮小疖，不于后天脾胃气血中求之，亦无益也。奈何近医一遇疮肿，便作外染之
邪，有余之毒，克削寒凉，清解疏利，轻者热邪外散，气血亦可宣和，重者气血更伤，
难溃难长，每多内攻不救，余次孙因母久患阴虚夜热之症，生下百余日，遍体癞疮，痛
痒烦啼，旦夕无宁刻，余用生地、当归身、丹皮、赤芍、萆 、首乌、金银花、连翘、
土贝母、甘草节、鳖虫、胡麻子、土茯苓、木通节，大剂乳母日夜进服，数十剂后，湿
热下赴，两足溃烂，清水淋漓，指甲皆脱乳母傍人，近者莫不传染，此先天胎禀热毒
之气，已尽出于外矣。后于耳后结一大毒，此阴亏而无根之火乘虚而凝聚于其部也。余
以八味加牛膝五味子煎汤，与孙自服，数剂之后，高肿溃脓而愈，渐后气血精液衰润，
疮靥干枯，或愈或发，能保其不内攻乎，余思精不足者补之以味，乃以羊肉四两，煎
汤，入生黄 四钱，当归身二钱、金银花三钱、蜜酒炒生麻四分、生姜三片，大枣二
钱（人参），制附子二钱，浓煎至半碗，人参一两，煎至半钟后冲服；口渴时另用熟地黄二两、生麦冬五钱、人参八钱，煎取浓汁约一碗代茶饮。服用三四剂后，头部溃烂处如雨的冷汗逐渐收敛，手足心干燥如火的症状逐渐滋润温和，舌苔黑色逐渐减退，神色逐渐清爽，饮食欲望逐渐恢复，发热退去、咳嗽停止。此后早晨用生脉饮送服十补丸四五钱，午后以归脾汤加减制成煎膏并炼蜜为丸，如弹子大小，用桂圆肉汤化开服用一丸，不到一个月便痊愈，精神比病前更好。
部主政山西李老先生，为人端正宽厚仁爱，与我相契已有十年。癸亥年进入京城，先生患有足疾，疼痛难忍，长时间无法行走，医生使用治疗香港脚（下肢慢性炎症）祛风燥湿的药物，久服无效，饮食无味，精神更加疲惫，盼望我诊治已久。一到京城城门，便来邀请我去诊视。诊得两寸脉洪大而数，两关脉虚弱，两尺脉更微。我说：人们只知道洪数是实热，但不知道六脉洪数有力才是实热。如果洪数仅见于寸脉，则是上热中虚，而下寒。脉大而数，是阳气浮越于外；脉细而数，是阴液枯竭于内。这些都不是实热，都应当按虚证论治。如今老先生的脉象，是孤阳浮越在上，而里实无阳。阳气，《内经》所说如同天上的太阳。阳气不到的地方，就像太阳照射不到的地方，阴寒凝滞而成病。凡阴气必随阳气生长，所以气病则血亦病。再用驱风燥湿药，有病则病邪承受，无病则气血更受损伤。脾主四肢，痿证取阳明经，肝肾筋骨，多脏皆宜重视。于是以前方加生杜仲三钱。杜仲古名思仙术，盐酒炒则入内走腰肾，酒炒则走周身筋骨，且能祛风，不炮制则下达，其性能使筋骨相连。凡初病轻病，或一脏一腑受伤，久病重病必脏腑牵连俱困。脏属阴，可胜纯阳之药；腑属阳，必加阴药制约其潜热，务使五脏调和，互为灌溉，脏脏气血自生，脏脏有邪难隐匿，根本之处得力，枝叶自然繁荣，邪气不待攻伐而解。先生大喜，十余剂后，自觉康复胜过从前。此后早晨以生脉饮送服八味丸加鹿茸、牛膝、杜仲的丸药五钱，午后以人参、炙黄芪、枣仁、当归、炒白芍、炒白术、茯苓、生杜仲、续断、牛膝、薄桂、大枣煎服，调理月余，精神健旺，步履如初。适逢我南归，先生送我而言说：在生一日，感激一日也。
刑部主政姚老先生，夏季奉命赴河南审理案件，根据期限往返，劳顿太甚，回京正当衙门办事，忽然手足麻木不能举动，于是回到私宅，招一位医生诊视说：这是中暑。服用香薷饮，觉得非常不安，于是延请我诊治。按其脉洪大而空，这是血脱而非暑伤气的脉象。不敢直指其非，只说：恐怕将来脚上又中暑了。先生未领会我的意思，我回寓所少顷，果然脚也麻木，不能举动，先生才醒悟，遣人招我求治。此时口舌强直，自汗等症状都出现了。于是以前方加减分两，连服两剂，汗减少而神志始清，后用河间地黄饮子加减而愈。令弟中翰二先生，偶然索要我诊脉，两寸洪大倍于平常，两尺微弱倍甚。如同出自两人之手。我说：先生无病而得此脉，诸事宜谨慎。先生说：脉主将来何病？我说：恐怕也类似令兄先生的病，而危害则超过他。他说：家兄中风之症，不为轻矣。难道有更重于此者吗？抑或愚弟兄或许病各不同，而岂必都犯中风呢！况且家兄因无子故，或许未能绝欲，弟弟则独宿旅邸多年，可以自信，倘若病出意外，再求调治未晚也。我见他很忽略，也不复进言。一月之后，无故卒倒，急遣人招我。我说：形未病而脉先病，根本萎之于中久矣。岂可救乎？力请视之，脱症具备，已不能药矣。次日而卒。令兄先生尤以身命自重，弃官告假而归。后叩其故，大先生果因无子而多欲，二先生果绝欲而日醉酒，可见酒色害人一也。
长儿之太翁，高年且患足疾初愈，适于途中遇雨，疾趋而回，未几身热自汗，头疼咳嗽，继而吐血，饮食不思，精神狼狈，延请我诊视。两寸皆洪大而数，右关两尺甚微，这是劳伤中气，脾不能统血也。咳嗽者是火烁于肺也。身热者是元阳浮越也。自汗者是气虚不能摄液也。头疼者是血虚火冒也。悉用前方熟地一两、炒麦冬四钱、炒白术二钱、牛膝三钱、五味子一钱、制附子一钱二分，另煎人参冲服。数剂之后，咳嗽吐血俱止，身凉进食而痊。后早晨生脉饮送服加减肾气丸，午后以归脾汤加减服之，精神如旧。
徐管朗先生夫人年七十余岁，忽患重疟，上则咳嗽吐血，下则泄泻，粒米不进，人事不省，胸膈胀甚，脉则两寸细数，左关弦大，右关甚微，两尺重按不起，势甚危笃。先生祷于关夫子前，得黄阁开时延故客之签，乃思十年前大病，余所治疗，因复来招。按其脉知为阴虚内热，阳虚外寒，肝无血养而强，脾无气充而弱，血无所统而吐，谷无所运而泻，气无所纳而胀，悉属本气为病。乃用前方冲参汤服，疟止神清。奈病患自谓胸有停滞，人参补药，必不肯服，乃令管朗先生以八味丸、云消食丸进之，病患始允，日以参汤送服，胸胀泄泻、吐血诸症余愈，饮食精神，俱倍于平日。
余侄孙年止三岁，身热咳嗽数日，适乡间痘疮盛行，因有近医以疏散风痰，兼行托痘为治，至六七日后，热势更甚，干哕吐蛔，神昏气促，食乳即吐，目闭不语，面青目直，哭无涕泪，乃来告急。余视之，此子先天不足，故面色㿠白皮细，初受外感虽轻，而中气之虚已甚，复加疏散透托，元阳汤液皆两亡矣。乃用前方熟地五钱、炒麦冬二钱、炒白术三钱、牛膝二钱、五味子四分、制附子八分，另煎人参二钱冲服。一剂热减，而一眼一鼻少有涕泪，二剂之后，始能受乳，热更减，而涕泪俱有矣。三四剂后，热退神爽，复以生脉饮，每早化服八味丸一钱二分，旬日而精神平复。
沈定老之孙媳，曾患久疟，已而成痞常发，胀痛不堪，久服顺气化痞而不效，今复壮热咳嗽，胸次胀疼更甚，延请我诊视。按其脉两寸独洪，余皆微弱，右关尺尤甚，乃知土位无母，子母两虚，中空外浮之假象。投以前方一二剂，而胀痞倍加。余曰：此药力攻击，浊气解散而未降也，当再服之。复进二三剂，人参倍用，所谓少则壅滞，多则宣通也。果数日后咳嗽身热俱退，饮食进而精神健旺，其两载之痞胀，一日化为正气而守丹田，毫无形迹矣。
金绍老太夫人，脾肾素虚，因岁事积劳之后，忽眩晕不醒，妄有见闻，语言杂乱，急求请治。诊其脉细数无伦，真阴真阳并亏已极。余曰：乘此初起，即为挽回，勿少担延，愈久愈虚愈脱，即用前方日进二剂，每剂人参二钱，日愈一日，不十日而全痊。
庠生徐山公，偶患似疟非疟，医以柴胡汤连进数剂之后，渐至不省人事，口噤僵卧，渠家内外，俱以为断无生理矣。请余诊之，不过欲决其死期耳。余曰：阳虚作寒，阴虚作热，误为疟治而未绝，便非绝症也。急以前汤，每剂人参一两，煎汁冲服，三日而苏，复重温补而痊愈。
翰院河南刘老先生令郎，乡试入都，长途冒暑，气已伤矣。到寓日夜课读，未几壮热头疼，咳嗽干哕，日夜不寐，精神困顿，众皆以其先受暑气，继感风寒，与余商治。按其脉两寸俱洪，两尺俱弱，右关沉取俱无，右尺倍弱于左。余思此犯无胃气之症参。若不直入挽救无济也。理直温补脾肾二家，理中八味并不可少，奈主人以暑天热病，断勿肯用，必欲另方乃服。余曰：病家徒认候，医家必据脉，今令郎之脉候迥别，脉为病患真源，候多病之假象，土为万物之母，故诸病无胃气则死，阳病见阴脉者死，症已十分沉困，奚容再误于药，彼此勿听，坐视数日，病势益甚，身益野狼狈，复延余商。按其脉仍故，但燥涩无力，较前过之，此久热阴阳愈伤矣。余复举前方为治，况此即古方附子理中汤、去炮姜甘草，加熟地、炒麦冬、牛膝、五味子四味耳。何必虑之，午后又服一剂，以八味去丹皮、泽泻，加牛膝、生麦冬、五味子三味冲参汤服，每剂人参八钱，服后甚安，主人病患乃斗胆服之，数日之后，头疼身热咳嗽渐愈，而哕声间尚有之，然仍脾胃脉不起，毫不思食也。余思身热头疼既退，火已藏舍矣。尚不喜食者，未及补土之剂也。乃早晨以生脉饮送服八味之去丹皮、泽泻，加鹿茸、五味子之加减十补丸四钱，晚用加减归脾汤去木香、甘草，加五味子、肉桂，一补先天，一补后天，渐渐喜食，脉起而康强。先生乔梓始知从前之壮热头疼皆本气为病，全非外感也。深以为喜。同时少宰彭老先生之三公郎亦患是病，身热两月，久服补中益气加减，升麻、柴胡、陈皮、半夏已数十剂矣。殊不知地黄丸以降为升，盖浊阴下降，清阳自升，肾有补无泻，故宜久服者也。补中汤以升为降，盖使清气上升，浊气降散，东垣为虚人发散而设，故不宜久服者也。且时当夏月，天之阳气浮越地表，人之阳气浮越身表，况复犯阳浮发热之病，又伤升浮阳气之药，以致汗多，久热不已，阴阳两亡，中宫元气，下焦阳气大虚，《经》曰：脉平阳秘，精神乃治，阴阳离决，精气乃绝，所以面青浮肿，肚腹胀硬，心下痞隔，咳嗽咽痛，口多甜涎，壮热畏寒，五心燥热，日不干渴，足胫常冷，脉则两寸乍洪乍数，两关无力，两尺更微，其右关右尺倍弱，乃系脾肾两亏，上实下虚，外热内寒，真寒假热之症也。余早晨以生脉饮送服河车膏丸、十补丸四钱、午间食前，以前方熟地一两二钱、炒麦冬三钱、炒白术四钱、牛膝二钱四分、五味子八分、制附子一钱五分，另用人参一两，煎汁冲服，可喜两月不退之热，服此壮热渐减，旬余畏寒身热全退，面肿肚胀全消，面青咽痛痊愈，饮食渐知香味矣。但小腹未能平复，继进加减附子理中汤数剂，大便下如蟹沫而不臭，十余次，便时肛门自觉甚冷，岂非里无阳气，以致阴寒久滞于中之验乎，自后小腹始软，六脉平和，此阳和冰解之象，乃佳兆也。奈有一医从傍鼓惑，许以三剂痊愈，彭老先生喜闻其言而听之，复用发散消痰，如苏叶、柴胡、腹皮、浓朴、陈皮、半夏之类，非补中益气加减，则六君子加减，以致身热复发，汗出复多，烦渴减食，阴阳并竭，人生所仗之精气神，终被升柴陈半搬运殆尽而后已，可惜余一月调养之苦心，去病十有其七，更可惜孝友性成，谦恭仁浓之佳公子复被庸医数十剂之升柴，将生之气复虚，遂致不起，惜哉！
老友谢登之年七十余矣。偶于途中遇雨疾趋而归，继发疟疾甚危，遇发随必大便，遇便随必昏晕欲绝，伊芳亲投以疏散，而势愈甚。余曰：冒雨果受寒，而宜疏散矣。独不思《经》曰：惊而夺精，汗出于心，持重远行，汗出于肾，疾走恐惧，汗出于肝，摇体劳苦，汗出于脾，五脏俱伤矣。凡入者为实，出者为虚，大便出而即昏晕，元气欲脱矣，尚可以既散之微寒为重，而垂绝之无气为轻也。急以人参三钱、白术六钱、炮姜一钱、五味子、炙甘草各一钱、制附子一钱二分，投服而愈。或曰：愈则愈矣，但五味酸敛，恐有余邪未尽也。嗟嗟，是尚以疟症为有迹之真邪，而未达阴阳虚极之变现，顾标罔顾本之见也。且有附子通经达络之大功，虽有强邪，无地可匿，况更有炙草炮姜开发之药，能不少佐敛阖，以为收摄元气之用耶。
立斋曰：气血虚而变现诸症，莫可名状，故贵治者熟得气血虚实之情，阴阳变化之用，脉气真假之征，则虽病状变现百出，总不外乎阴阳气血虚实中以尽之。至于诸疮诸肿，感六腑者发于皮毛肌肉，感于五脏者发于经络骨髓，莫非阴阳气血相滞而生，气血有余，则红肿高起而为阳毒，气血不足，则阴塌平陷而为阴毒。丹溪所谓阴滞于阳，阳滞于阴，百病皆由于此，不止痈疽而已。《经》云：邪之所凑，其正必虚，着而不去，其病为实是也。本阴阳不知，气血涩滞，阳不足则寒湿凝泣，阴不足则火热沸腾，乃是血为之浊，气为之乱，隧道阻滞，犹水流不污。今气血既凝而且郁，能不各随经络渗入脉中，溢于脉外，腐溃成脓乎？名之曰：毒者，气血不知之谓。如人之气不和平而有毒性之类也。然大肿大毒，发于骨髓经络者，不于先天水火真阴阳求之，不能疗也。若诸疮小疖，不于后天脾胃气血中求之，亦无益也。奈何近医一遇疮肿，便作外染之邪，有余之毒，克削寒凉，清解疏利，轻者热邪外散，气血亦可宣和，重者气血更伤，难溃难长，每多内攻不救，余次孙因母久患阴虚夜热之症，生下百余日，遍体癞疮，痛痒烦啼，旦夕无宁刻，余用生地、当归身、丹皮、赤芍、萆薢、首乌、金银花、连翘、土贝母、甘草节、鳖虫、胡麻子、土茯苓、木通节，大剂乳母日夜进服，数十剂后，湿热下赴，两足溃烂，清水淋漓，指甲皆脱乳母傍人，近者莫不传染，此先天胎禀热毒之气，已尽出于外矣。后于耳后结一大毒，此阴亏而无根之火乘虚而凝聚于其部也。余以八味加牛膝五味子煎汤，与孙自服，数剂之后，高肿溃脓而愈，渐后气血精液衰润，疮靥干枯，或愈或发，能保其不内攻乎，余思精不足者补之以味，乃以羊肉四两，煎汤，入生黄芪四钱，当归身二钱、金银花三钱、蜜酒炒生麻四分、生姜三片，大枣二
Qian (Ren Shen, Ginseng Root), Zhi Fuzi (Prepared Aconite Root) 2 qian, decocted strongly to half a bowl; Ren Shen (Ginseng Root) 1 liang, decocted to half a zhong, taken with the liquid. If thirsty, use Shu Di Huang (Prepared Rehmannia Root) 2 liang, Sheng Mai Dong (Ophiopogon Tuber), and Ren Shen (Ginseng Root) 8 qian, decocted strongly to about one bowl as a tea substitute. After three or four doses, the profuse sweating from the ulcerated head gradually subsides, the dryness and heat in the palms and soles gradually become moist and mild, the black tongue coating gradually diminishes, the spirit and complexion gradually clear, and the desire for food gradually returns. The fever recedes and the cough stops. Thereafter, in the morning, Sheng Mai Yin (Generating the Pulse Decoction) is used to deliver Shi Bu Wan (Ten Tonics Pill), 4-5 qian. In the afternoon, Gui Pi Tang (Restore the Spleen Decoction) modified is decocted into a paste and refined with honey into pills the size of quail eggs, dissolved in Long Yan Tang (Longan Fruit Decoction) and one pill taken. Within less than a month, recovery is achieved, and the spirit is even better than before.
Li Laoyensheng, Minister of Works from Shanxi, was upright and benevolent, having been my close friend for ten years. In the Guihai year, he entered the capital suffering from a foot ailment, unbearable pain, and inability to walk for a long time. Physicians had prescribed wind-dispelling and dampness-drying medicines for Xianggangjiao (Hong Kong Foot, a term often referring to gout or lower limb edema), but long-term use was ineffective. His appetite declined, and his spirit grew more fatigued. He had been hoping for my treatment for some time. Upon entering the capital, he immediately invited me to examine him. The pulse at both Cun (Inch) positions was surging and rapid, both Guan (Carpal) positions were weak and loose, and both Chi (Cubit) positions were even more faint. I said: People know that a surging and rapid pulse indicates excess heat, but they do not realize that only when all six pulse positions are surging, rapid, and forceful does it indicate excess heat. If surging and rapid pulses are seen only at the Cun positions, it indicates heat above, deficiency in the middle, and cold below. A large and rapid pulse indicates Yang floating outward; a fine and rapid pulse indicates exhaustion of Yin inside. None of these are excess heat; all should be discussed as deficiency patterns. Now, the old gentleman's pulse shows solitary Yang floating upward, while the interior lacks Yang. Yang Qi, as stated in the Classics, is like the sun in the sky. Where Yang Qi does not reach, like places where sunlight does not penetrate, Yin-cold coagulates and causes disease. All Yin must grow with Yang; thus, if Qi is diseased, Blood is also affected. Using wind-dispelling and dampness-drying drugs again would benefit the disease if present, but if absent, it would further injure Qi and Blood. The Spleen governs the four limbs; for flaccidity syndromes, the Yangming channels are selected. For the Liver, Kidney, sinews, and bones, multiple organs require emphasis. Therefore, I added Sheng Duzhong (Raw Eucommia Bark) 3 qian to the previous formula. Duzhong was anciently called Sixian Shu (Six Immortals Herb). Salt-wine frying directs it inward to the waist and Kidneys; wine-frying directs it to the sinews and bones throughout the body, and it can dispel wind. Without processing, it descends; its nature connects sinews and bones. For initial, mild diseases affecting one Zang or Fu organ, chronic or severe diseases inevitably involve mutual distress among Zang and Fu organs. Zang organs are Yin and can withstand pure Yang herbs; Fu organs are Yang and require Yin herbs to restrain latent heat, ensuring the five Zang organs harmonize and irrigate each other. Qi and Blood generate naturally within each Zang, making it difficult for pathogens to hide. When the root is strengthened, the branches flourish naturally, and pathogens resolve without needing direct attack. The gentleman was greatly pleased. After more than ten doses, he felt healthier than before. Thereafter, in the morning, Ba Wei Wan (Eight-Ingredient Pill) modified with Lurong (Deer Antler) and Nixi (Achyranthes Root) was delivered with Sheng Mai Yin (Generating the Pulse Decoction), 5 qian. In the afternoon, Ren Shen (Ginseng Root), Zhi Huangqi (Honey-fried Astragalus Root), Zaoren (Ziziphus Seed), Danggui (Angelica Sinensis), Chao Baishao (Stir-fried White Peony Root), Chao Baizhu (Stir-fried Atractylodes Rhizome), Fuling (Poria), Sheng Duzhong (Raw Eucommia Bark), Xuduan (Dipsacus Root), Nixi (Achyranthes Root), Bo Gui (Thin Cinnamon Twig), and Dazao (Jujube) were decocted and taken. After over a month of regulation, his spirit was vigorous, and his gait returned to normal. As I was returning south, the gentleman saw me off and said: "For every day I live, I am grateful."
Yao Laoyensheng, Minister of Justice, was ordered in summer to travel to Henan for trials, rushing back and forth according to deadlines, leading to extreme fatigue. Upon returning to the capital and resuming official duties, his hands and feet suddenly became numb and immobile. He returned home and consulted a physician who said: "This is heatstroke." He took Xiangxu Yin (Elsholtzia Drink) and felt very uneasy, so he invited me. Palpating his pulse, it was surging and empty. This is a pulse of Blood depletion, not Qi injury from heatstroke. Not daring to directly contradict the previous diagnosis, I said: "I fear your feet may suffer heatstroke in the future." The gentleman did not understand my meaning. Shortly after I returned to my residence, his feet indeed became numb and immobile. Realizing this, he sent someone to summon me. At this time, symptoms included stiff tongue and mouth, spontaneous sweating, etc. I used the previous formula with modified dosages. After two consecutive doses, sweating decreased slightly, and clarity of spirit began. Later, Hejian Dihuang Yinzi (Hejian's Rehmannia Decoction) modified cured him. The gentleman's younger brother, Zhonghan Er Laosheng, occasionally requested my consultation. His Cun pulses were twice as surging as usual, and his Chi pulses were twice as faint. It seemed like two different people. I said: "You have no disease but obtained this pulse; you should be cautious." He asked: "What disease does the pulse predict?" I said: "It is likely similar to your elder brother's condition, but the harm will be greater." He said: "My elder brother's stroke was not minor. Could there be anything heavier? Or perhaps our illnesses differ, and we don't necessarily both suffer stroke! Moreover, since my elder brother has no son, he may not have abstained from sex, whereas I have slept alone in lodgings for many years; I can be confident. If an unexpected illness occurs, seeking treatment later will not be too late." Seeing his negligence, I did not speak further. One month later, he collapsed without cause, and emergency summons were sent. I said: "The form is not yet diseased, but the pulse is already diseased; the root has been withered in the center for a long time. How can it be saved?" Despite urgent requests to examine him, withdrawal symptoms were complete, and medicine could no longer help. He died the next day. The elder brother, valuing life highly, resigned and returned home. Later inquiry revealed the elder brother indulged due to lack of heirs, while the younger brother drank excessively daily despite abstinence. Thus, alcohol and lust harm equally.
The great-grandfather of my eldest son, advanced in age and just recovering from a foot ailment, encountered rain on the road and hurried back. Soon, he developed fever, spontaneous sweating, headache, and cough, followed by hemoptysis, loss of appetite, and mental distress. I was invited to consult. Both Cun pulses were surging and rapid; the Right Guan and both Chi pulses were very faint. This is labor injuring Middle Qi, with the Spleen unable to control Blood. Coughing is fire scorching the Lung. Fever is Yuan Yang floating outward. Spontaneous sweating is Qi deficiency failing to secure fluids. Headache is Blood deficiency with Fire rising. I used the previous formula: Shu Di Huang (Prepared Rehmannia Root) 1 liang, Chao Maidong (Stir-fried Ophiopogon Tuber) 4 qian, Chao Baizhu (Stir-fried Atractylodes Rhizome) 2 qian, Nixi (Achyranthes Root) 3 qian, Wuweizi (Schisandra Berry) 1 qian, Zhi Fuzi (Prepared Aconite Root) 1.2 qian, with Ren Shen (Ginseng Root) decocted separately and taken with the liquid. After several doses, coughing and hemoptysis stopped, body temperature normalized, appetite returned, and he recovered. Later, in the morning, Jian Shen Qi Wan (Modified Kidney Qi Pill) was delivered with Sheng Mai Yin (Generating the Pulse Decoction); in the afternoon, Gui Pi Tang (Restore the Spleen Decoction) modified was taken. Spirit returned to normal.
Madam of Mr. Xu Guanlang, over seventy years old, suddenly suffered severe malaria. Above, she coughed and vomited blood; below, she had diarrhea, ate nothing, and lost consciousness. Her chest and diaphragm were severely distended. The pulse was fine and rapid at both Cun, wiry and large at the Left Guan, very faint at the Right Guan, and unpressable at both Chi positions. The situation was critical. The gentleman prayed before the statue of Lord Guan and received a lot indicating "Yellow Pavilion opens, extending to old guests," recalling a major illness ten years prior that I had treated, so he invited me again. Palpating the pulse, I knew it was Yin deficiency with internal heat and Yang deficiency with external cold. The Liver lacked Blood nourishment and became hyperactive; the Spleen lacked Qi filling and became weak. Blood had no controller and vomited; grain had no transport and diarrhea ensued; Qi had no reception and distension occurred. All belonged to disorders of the fundamental Qi. I used the previous formula with Ren Shen decoction. Malaria stopped, and spirit cleared. However, the patient claimed chest stagnation and refused Ginseng tonics. I instructed Mr. Guanlang to offer Ba Wei Wan (Eight-Ingredient Pill) and Yun Xiao Shi Wan (Cloud Digestion Pill). The patient agreed, taking them daily with Ginseng decoction. Chest distension, diarrhea, and hemoptysis largely resolved; diet and spirit doubled compared to usual.
My nephew's grandson was only three years old, suffering fever and cough for several days. During an epidemic of smallpox in the countryside, a nearby physician treated him with wind-dispersing and phlegm-resolving herbs combined with pustule-promoting methods. By the sixth or seventh day, fever intensified, accompanied by dry retching, vomiting roundworms, coma, shortness of breath, vomiting milk upon feeding, closed eyes, silence, blue face, staring eyes, and crying without tears or mucus. They came to report the emergency. I observed: This child has congenital insufficiency, hence pale skin and fine texture. Although the initial external contraction was mild, Middle Qi deficiency was severe. Adding dispersing and promoting methods caused both Yuan Yang and body fluids to perish. I used the previous formula: Shu Di Huang (Prepared Rehmannia Root) 5 qian, Chao Maidong (Stir-fried Ophiopogon Tuber) 2 qian, Chao Baizhu (Stir-fried Atractylodes Rhizome) 3 qian, Nixi (Achyranthes Root) 2 qian, Wuweizi (Schisandra Berry) 4 fen, Zhi Fuzi (Prepared Aconite Root) 8 fen, with Ren Shen (Ginseng Root) 2 qian decocted separately and taken with the liquid. After one dose, fever decreased, and slight tears/mucus appeared in one eye/nose. After two doses, he could take milk, fever decreased further, and tears/mucus appeared fully. After three to four doses, fever receded, spirit refreshed. Sheng Mai Yin (Generating the Pulse Decoction) was given every morning with Ba Wei Wan (Eight-Ingredient Pill) 1.2 qian dissolved. Within ten days, spirit recovered.
Granddaughter-in-law of Shen Dinglao had suffered chronic malaria, which evolved into fixed masses (Pi) causing unbearable distension and pain. Long-term use of Shun Qi Hua Pi (Regulate Qi Transform Mass) was ineffective. Now, high fever and cough returned, with worse chest distension and pain. I was invited to consult. Palpating the pulse, only the Cun positions were surging; the rest were faint, especially the Right Guan and Chi. I realized Earth position lacked Mother (Kidney), resulting in mutual deficiency of Mother and Child, a false image of emptiness inside and floating outside. Administering the previous formula for one or two doses increased distension and masses. I said: "This is the drug force attacking; turbid Qi is dispersing but not descending. Continue taking it." After another two or three doses, doubling Ren Shen (Ginseng Root), as stated: "Small doses cause stagnation, large doses promote circulation." Indeed, after several days, cough and fever receded, appetite improved, and spirit became vigorous. The two-year-old mass/distension transformed into righteous Qi guarding the Dantian overnight, leaving no trace.
Lady Jin Shao, constitutionally deficient in Spleen and Kidney, after accumulating fatigue during year-end affairs, suddenly suffered vertigo, unconsciousness, hallucinations, and disordered speech. Urgent treatment was sought. Palpating her pulse, it was fine and rapid beyond measure, indicating extreme deficiency of True Yin and True Yang. I said: "Seize this early stage to reverse it; do not delay. The longer it lasts, the more deficient and withdrawn it becomes." I used the previous formula, two doses daily, each containing 2 qian of Ren Shen (Ginseng Root). Day by day, she improved, and within ten days, full recovery.
Xiangsheng Xu Shangong occasionally suffered a condition resembling malaria but not malaria. After several doses of Chaihu Tang (Bupleurum Decoction) by a physician, he gradually became unconscious, jaw locked, lying rigid. His family believed there was no hope. Inviting me to diagnose, they merely wanted to determine the time of death. I said: "Yang deficiency causes cold, Yin deficiency causes heat. Misdiagnosed as malaria but not fatal, it is not a terminal case." Urgently, I used the previous decoction, 1 liang of Ren Shen (Ginseng Root) per dose, decocted and taken with the liquid. He revived in three days, then recovered with continued warm tonification.
Young master of Mr. Liu from Henan Academy, traveling to the capital for provincial exams, exposed to summer heat, Qi was already injured. Upon arriving at the inn, he studied day and night. Soon, high fever, headache, cough, dry retching, insomnia, and mental fatigue set in. Everyone thought he first caught summer heat, then wind-cold, and consulted me. Palpating the pulse, both Cun were surging, both Chi were weak, Right Guan was imperceptible on deep pressure, and Right Chi was twice as weak as Left. I thought this violated the "No Stomach Qi" pattern. Without direct rescue, it would be useless. Directly warming and tonifying Spleen and Kidney, Lizhong Wan (Regulate the Middle Pill) and Ba Wei Wan (Eight-Ingredient Pill) were indispensable. However, the host, citing summer heat disease, absolutely refused, insisting on another prescription. I said: "Patients rely on symptoms; physicians must rely on pulse. The young master's pulse and symptoms are distinct. Pulse is the true source; symptoms are often false images. Earth is the mother of all things; thus, diseases without Stomach Qi lead to death. Yang diseases with Yin pulses lead to death. The condition is already critically severe; how can we err further with medicine?" Ignoring each other, we watched for several days. The condition worsened, body became more distressed. Re-inviting me, the pulse remained the same but dry, rough, and weaker than before, indicating prolonged heat further injuring Yin and Yang. I proposed the previous formula again. This is essentially Gu Fang Fuzi Lizhong Tang (Ancient Formula Aconite Regulate Middle Decoction), removing Pao Jiang (Fried Ginger) and Gancao (Licorice), adding Shu Di Huang (Prepared Rehmannia Root), Chao Maidong (Stir-fried Ophiopogon Tuber), Nixi (Achyranthes Root), and Wuweizi (Schisandra Berry). Why worry? Another dose was taken in the afternoon: Ba Wei Wan (Eight-Ingredient Pill) removing Danpi (Moutan Cortex) and Zexie (Alisma), adding Nixi (Achyranthes Root), Sheng Maidong (Fresh Ophiopogon Tuber), and Wuweizi (Schisandra Berry), taken with Ren Shen decoction, 8 qian Ren Shen per dose. After taking, he felt very comfortable. The host and patient boldly continued. Days later, headache, fever, and cough gradually improved, though occasional retching persisted. However, Spleen/Stomach pulse remained unraised, and no appetite. I thought: Since fever and headache receded, Fire has retreated. Lack of appetite means Spleen-tonifying agents were insufficient. Morning: Sheng Mai Yin (Generating the Pulse Decoction) delivering modified Shi Bu Wan (Ten Tonics Pill) removing Danpi/Zexie, adding Lurong (Deer Antler) and Wuweizi (Schisandra Berry), 4 qian. Evening: Modified Gui Pi Tang (Restore the Spleen Decoction) removing Muxiang (Aucklandia Root) and Gancao (Licorice), adding Wuweizi (Schisandra Berry) and Rougui (Cinnamon Bark), tonifying Pre-Heaven and Post-Heaven respectively. Gradually, appetite returned, pulse rose, and health strengthened. Father and son finally realized the previous high fever and headache were fundamental Qi disorders, not external contractions. They were deeply pleased. Meanwhile, Third Young Master of Shaozai Peng Laoyensheng suffered the same disease. Fever lasted two months. Long-term use of modified Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Shengma (Cimicifuga Rhizome), Chaihu (Bupleurum Root), Chenpi (Tangerine Peel), and Banxia (Pinellia Tuber) totaled dozens of doses. Little did they know: Dihuang Wan (Rehmannia Pill) lowers to raise; turbid Yin descends, clear Yang rises naturally. Kidney has tonification but no purgation, suitable for long-term use. Buzhong Tang raises to lower; clear Qi ascends, turbid Qi descends and disperses. Dongyuan designed it for dispersing in deficient persons, unsuitable for long-term use. Moreover, in summer, Heaven's Yang floats on the surface, and Human Yang floats on the body surface. Suffering Yang-floating fever disease and using ascending-floating Yang-injuring drugs caused excessive sweating, prolonged fever, dual exhaustion of Yin and Yang, severe deficiency of Central Palace Yuan Qi and Lower Jiao Yang Qi. The Classics say: "Pulse level, Yin secret, spirit governs. Yin-Yang separation, essence-Qi perishes." Hence, blue face, edema, hard abdominal distension, epigastric obstruction, cough, sore throat, sweet saliva, high fever with aversion to cold, hot palms/soles/chest, thirstless, cold calves/shins. Pulse: Cun fluctuates between surging and rapid; Guan powerless; Chi faint, Right Guan/Chi twice as weak. This is Spleen-Kidney dual deficiency, upper excess/lower deficiency, external heat/internal cold, true cold/false heat. Morning: Sheng Mai Yin (Generating the Pulse Decoction) delivering Heche Gao Wan (Placenta Paste Pill) and Shi Bu Wan (Ten Tonics Pill), 4 qian. Before lunch: Previous formula Shu Di Huang (Prepared Rehmannia Root) 1.2 liang, Chao Maidong (Stir-fried Ophiopogon Tuber) 3 qian, Chao Baizhu (Stir-fried Atractylodes Rhizome) 4 qian, Nixi (Achyranthes Root) 2.4 qian, Wuweizi (Schisandra Berry) 8 fen, Zhi Fuzi (Prepared Aconite Root) 1.5 qian, with Ren Shen (Ginseng Root) 1 liang decocted separately and taken. Fortunately, the unremitting fever of two months gradually decreased with this strong heat-clearing approach. Over ten days, aversion to cold and fever completely receded, facial swelling and abdominal distension disappeared, blue face and sore throat healed, appetite recognized flavors. However, lower abdomen did not flatten. Continued with modified Fuzi Lizhong Tang (Aconite Regulate Middle Decoction) for several doses. Stool resembled crab foam, odorless, passed more than ten times, anus felt very cold during defecation. Was this not proof of interior lacking Yang Qi, causing Yin-cold stagnation in the center? Thereafter, lower abdomen softened, six pulses became peaceful. This was the image of Yang harmony melting ice, a good omen. Alas, a physician beside him incited doubt, promising cure in three doses. Old Master Peng happily listened and resumed dispersing and phlegm-resolving herbs such as Ziye (Perilla Leaf), Chaihu (Bupleurum Root), Fupi (Tangerine Peel), Houpo (Magnolia Bark), Chenpi (Tangerine Peel), Banxia (Pinellia Tuber), either modified Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Liujunzi Tang (Six Gentlemen Decoction). Consequently, fever recurred, sweating increased, irritability/thirst decreased appetite, Yin and Yang exhausted. The Essence-Qi-Spirit relied upon by humans were ultimately transported away by Shengma, Chaihu, Chenpi, and Banxia until nothing remained. Pity my painstaking one-month regulation, which removed seven-tenths of the disease! More pitifully, the filial, friendly, humble, and benevolent young master, whose vitality was barely regenerating, was made deficient again by dozens of doses of ascending herbs by mediocre physicians, leading to death. What a pity!
Old friend Xie Dengnian, over seventy years old, encountered rain on the road, hurried home, and subsequently developed severe malaria. Each episode was followed by diarrhea, and each diarrhea episode was followed by syncope nearly unto death. His relatives administered dispersing herbs, worsening the condition. I said: "Encountering rain implies cold exposure, suitable for dispersing. But do you not recall the Classics: 'Shock steals Jing, sweat comes from Heart; carrying heavy loads/traveling far, sweat comes from Kidney; running fast/fear, sweat comes from Liver; shaking body/labor, sweat comes from Spleen.' Five Zang organs are all injured. What enters is excess; what exits is deficiency. Diarrhea followed immediately by syncope indicates Yuan Qi about to withdraw. Can we consider the already dispersed mild cold as heavy and the dying Qi as light?" Urgently, I prescribed Ren Shen (Ginseng Root) 3 qian, Baizhu (Atractylodes Rhizome) 6 qian, Pao Jiang (Fried Ginger) 1 qian, Wuweizi (Schisandra Berry) and Zhi Gancao (Honey-fried Licorice Root) 1 qian each, Zhi Fuzi (Prepared Aconite Root) 1.2 qian. Taken, he recovered. Someone said: "Recovered yes, but Wuweizi is sour and astringent; fear residual pathogen remains." Alas, this still views malaria as a tangible true pathogen, failing to reach the manifestation of extreme Yin-Yang deficiency, focusing on branch while ignoring root. Moreover, Fuzi (Aconite Root) has great merit in penetrating meridians and collaterals; even strong pathogens have nowhere to hide. Besides, there are Zhi Gancao (Honey-fried Licorice Root) and Pao Jiang (Fried Ginger) to develop and open; can they not assist astringency to gather and secure Yuan Qi?
Lizhai said: When Qi and Blood are deficient, manifesting various symptoms indescribable, the skilled practitioner must thoroughly understand the states of Qi/Blood deficiency/excess, the functions of Yin-Yang transformation, and the signs of pulse truth/falsehood. Then, although symptoms manifest in hundreds of ways, they are all encompassed by Yin-Yang, Qi-Blood, Deficiency-Excess. Regarding sores and swellings, those affecting Six Fu organs manifest on skin/hair/muscles; those affecting Five Zang organs manifest on meridians/bones/marrow. All arise from stagnation of Yin-Yang/Qi-Blood. Excess Qi-Blood results in redness/swelling/elevation (Yang Du); deficiency results in collapse/flattening (Yin Du). Danxi said: Yin stagnating in Yang, Yang stagnating in Yin, hundred diseases stem from this, not just carbuncles/ulcers. The Classics say: "Where pathogen gathers, Zheng Qi must be deficient; lingering and not departing, the disease becomes excess." Ignorance of Yin-Yang, stagnation of Qi-Blood: Yang insufficiency leads to cold-damp coagulation; Yin insufficiency leads to fire-heat boiling. Blood becomes turbid, Qi becomes chaotic, tunnels obstructed, like stagnant water. Now, Qi-Blood congealed and depressed, how can they not follow meridians, infiltrate vessels, overflow outside, rot, and form pus? Named "Du" (Toxin) refers to Qi-Blood ignorance. Like human Qi being unharmonious and toxic. Large swellings/toxins originating from bone marrow/meridians cannot be treated unless sought in Pre-Heaven Water/Fire True Yin-Yang. Small sores/pustules cannot benefit unless sought in Post-Heaven Spleen/Stomach Qi-Blood. Why do recent physicians, upon encountering sores/swellings, treat them as external infection/excess toxin, using harsh cooling/clearing/dispersing methods? Mild cases disperse heat externally, harmonizing Qi-Blood; severe cases injure Qi-Blood further, difficult to suppurate/heal, often leading to internal attack and death. My grandson's son, born over 100 days after his mother suffered chronic Yin-deficiency night fever, developed widespread eczema/sores, painful/itchy, crying day and night. I used Sheng Di Huang (Rehmannia Root), Danggui Shen (Angelica Sinensis Body), Danpi (Moutan Cortex), Chishao (Red Peony Root), Biba (Dioscorea Hypoglauca), Shouwu (Polygonum Multiflorum), Jinyinhua (Honeysuckle Flower), Lianqiao (Forsythia Fruit), Tubei Mu (Fritillaria Thunbergii Bulb), Gancao Jie (Licorice Joint), Biechong (Turtle Carapace), Humaizi (Sesame Seed), Tufuling (Smilax Glabra Rhizome), Mutong Jie (Akebia Stem Node). Large doses administered to the wet nurse day and night. After dozens of doses, damp-heat descended, legs ulcerated, clear fluid dripping, nails脱落. Wet nurse and bystanders, near ones infected. This Pre-Heaven fetal heat-toxin Qi had exited entirely outward. Later, a large toxin formed behind the ear, Yin deficiency with rootless fire condensing in that area. I used Ba Wei Wan (Eight-Ingredient Pill) plus Nixi (Achyranthes Root) and Wuweizi (Schisandra Berry) decocted, given to grandson to self-administer. After several doses, high swelling suppurated and healed. Gradually, Qi-Blood/Essence-Jade declined and dried, sores crusted, healing or recurring. Could internal attack be prevented? I thought: Essence insufficiency tonified with flavor. Thus, Lamb Meat 4 liang, decocted in soup, adding Sheng Huangqi (Raw Astragalus Root) 4 qian, Danggui Shen (Angelica Sinensis Body) 2 qian, Jinyinhua (Honeysuckle Flower) 3 qian, Mi Jiu Chao Sheng Ma (Honey-Wine Stir-fried Ephedra) 4 fen, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube) 2