乩方之风，于今尤甚。神仙岂为人治病，大率皆灵鬼耳，故有验有不验。余所目击者，
都门
章子雅患寒热，乩方用人参、黄 ，痰塞而殒。萧山李仪轩老年足痿，乩方用附子、熟地、
羌活、细辛等味，失血而亡。彼惑于是者，效则谓仙之灵，不效则谓其人当死，乃假手于仙
以毙之也。噫！是尚可与言乎？
药以养生，亦以伤生，服食者最宜慎之。秀水汪子黄孝廉同年（焘），工诗善书，兼谙医
术。道光乙未，余与同寓都城库堆胡同，求其治病者踵相接。丙申正月，汪忽患身热汗出，自以
为阳明热邪，宜用石膏，服一剂，热即内陷；肤冷泄泻神昏，三日遽卒。医家谓本桂枝汤证
，不当以石膏遏表邪也。嵊县吴孚轩明经鹏飞，司铎太平，壬寅六月科试，天气大热，身弱
事冗，感邪遂深。至秋仲疾作，初起恶寒发热，病势未甚，绍台习俗，病者皆饮姜汤，而不
知感寒则宜，受暑则忌也，服二盏，暑邪愈炽，遂致不救。又有不辨药品而致误者，归安
陈龙光业外科，偶因齿痛，命媳煎石膏汤服之，误用白砒，下咽腹即痛，俄而大剧，询知其
误，急饮粪清吐之，委顿数日始安，犹幸砒汤仅饮半盏，以其味有异而舍之，否则殆矣。吾
邑陈庄李氏子，夏月霍乱，延医定方，有制半夏二钱，适药肆入少，而购药者众，有新作伙
者，误以附子与之，服药后腹即大痛发狂，口中流血而卒。李归咎于医，医谓药不误，必有
他故，索视药渣，则附子在焉。遂控药肆于官，馈以金乃已。
世俗喜服热补药，如桂、附、鹿胶等，老人尤甚，以其能壮阳也，不知高年大半阴亏，
服之必液耗水竭，反促寿命。余见因此致害者多矣。
禽虫皆有智能，如虎中药箭而食青泥，野猪中药箭食荠 ，雉被鹰伤贴地黄叶，鼠中矾毒
饮泥汁，蛛被蜂螫以蚯蚓粪掩其伤，又知啮芋根以擦之，鹳之卵破以漏药缠之。方书所载，
不可胜数。今人不辨药味，一遇疾病，授命于庸医之手，轻者重，重者致死，亦可哀已。
凡服补剂，当审气体之所宜，不可偏一致害。叶天士《景岳全书发挥》云∶沈赤文年二
读书明敏过人，父母爱之，将毕姻，合全鹿丸一料，少年四人分服，赤文于冬令服至春初，
忽患浑身作痛，渐渐腹中块痛，消瘦不食，渴喜冷冻饮料，后服酒蒸大黄丸，下黑块无数，用水
浸之，胖如黑豆，始知为全鹿丸所化，不数日热极而死。同服三少年，一患喉痹，一患肛门
毒，一患吐血咳嗽，皆死。此乃服热药之害也。《叶天士医验录》云∶黄朗令六月畏寒，身
穿重棉皮袍，头带黑羊皮帽，吃饭则以火炉置床前，饭起锅热极，人不能入口者，彼犹嫌冷
，脉浮大迟软，按之细如丝。此真火绝灭，阳气全无之证也。方少年阳旺，不识何以至此，
细究其由，乃知其父误信人云∶天麦二冬膏，后生常服最妙。遂将此二味熬膏，令早晚日服
勿断，服之三年。一寒肺，一寒肾，遂令寒性渐渍入脏，而阳气寝微矣。是年春，渐发潮热
，医投发散药，热不退，而汗出不止，渐恶寒，医又投黄连、花粉、丹皮、地骨皮、百合，
扁豆、贝母、鳖甲、葳蕤之类，以致现症若此。乃为定方，用人参八钱，附子三钱，肉桂、
炮姜各二钱，川椒五分，白术二钱，黄 三钱，茯苓一钱，当归钱半，川芎七分。服八剂，
去棉衣，食物仍畏冷，因以八味加减，另用硫黄为制金液丹，计服百日而后全愈。此则服凉
药之害也。人之爱子者，可不鉴于此，而慎投补剂乎？
程杏轩治汪木工夏间寒热、呕泻、自汗、头痛。他医与疏表和中药，呕泻止，而发热不
口渴，形倦懒言，舌苔微黄而润，脉虚细。据《经》言脉虚身热，得之伤暑，因用清暑益气
汤加减，服一剂，夜热更甚，谵狂不安。次早复诊，脉更细，舌苔色紫肉碎，凝有血痕，渴
嗜饮冷，此必热邪内伏未透，当舍脉从证，改用白虎汤加生地、丹皮、山栀、黄芩、竹叶、
灯心，服药后，周身汗出，谵狂虽定，神呆手足冰冷，按脉至骨不现，（脉伏可与壶仙翁治
风热症参观。）阖目不省人事，知为热厥，舌苔形短而浓，满舌俱起紫泡，大如葡萄，并有
青黄黑绿杂色罩于上，辞以不治。其母哀恳拯救，乃令取紫雪蜜调涂舌，前方加入犀角、黄
连、元参以清热，金汁、人中黄、银花、绿豆以解毒，另用雪水煎药。厥回脉出，舌泡消苔
退，仅紫干耳。再剂热净神清，舌色如常。是役也，程谓能审其阳证似阴于后，未能察其实
证类虚于前，自咎学力未到，盖以初用清暑益气汤之误也。因思此汤，最不可轻用，况因伤
暑而脉虚，外见汗多口渴等症，则尤不当用也。
医家以丸散治病，不可轻信而服之。吾里有患痞者，求治于湖州某医，医授丸药服之，痞病
愈而变膨胀以死。又有婴儿惊风，延某医治之，灌以末药不计数，惊风愈而人遂痴呆，至长
不愈，其药多用朱砂故也。
世人喜服参术，虚者固得益，实证适足为害。苏州某官之母，偶伤于食，又感风邪，身热不
食，医者以其年高体虚，发散药中杂参术投之，病转危殆。其内侄某知医，适从他方至，诊
其脉，且询起病之由，曰∶右脉沉数有力，体虽惫而神气自清，此因伤食之后，为补药所误
，当以峻药下之。乃用大黄、槟榔、浓朴、莱菔子之属，一剂病如故。众疑其谬，某谓药力
未到，复投二剂，泄去积滞无算，病遂瘳。此可为浪服补药之鉴。
世俗每谓单方外治者，非比内服，可放胆用之，不知亦有被害者。《续名医类案》云∶一僧
患疮疥，自用雄黄，艾叶燃于被中熏之，翌日遍体 肿，皮破水出，饮食不入，投以解毒不
应而死。盖毒药熏入腹内而散真气，其祸如此。又云∶余举家生疮，家人亦用此方熏之，疮
不愈，未几銮儿出痘，症极凶，药不能下咽而殁，殆亦受其毒耳。窃意所患 ，当是热毒，
以热攻热，毒乃益炽。故凡用药，先宜审明阴阳虚实，不得谓外治无害而漫试之。
身躯肥瘦，何关利害？而随郡王子隆体肥，乃服芦茄丸以消。名位升沉，何与荣辱？寇莱公望
得相，乃服地黄兼饵莱菔。推之服金丹以求仙，反促其寿，饵春药以求子，转伤其生。皆逐末忘本者也。
鄱阳名医周顺，谓古方不可妄用，如《圣惠》、《千金》、《外台秘要》，所论病原脉
灸法，皆不可废，然处方分剂，与今大异，不深究其旨者，谨勿妄用。有人得目疾，用古方
治之，目遂突出。又有妇人产病，用《外台秘要》坐导方，反得恶露之疾，终身不瘥。余谓
方固勿妄用，近世所传单方，尤当慎择用之。朱子藩眉极少，方士令服末子药六七厘，眉可即
生，戒以服药后须避风。服之夕即有汗，偶值贼至，乃出庭除，及归寝，大汗不能止，几至
亡阳，后竟不寿。（见《折肱漫录》。）湖州胡氏子患水肿，服药不效，有教以黑鱼一尾，入
绿矾腹中，烧灰服之，服后腹大痛遽死。夫古方单方，用之得当，为效甚速，但当审病症之
所宜，且勿用峻厉之药，庶几有利而无弊耳。
士大夫不知医，遇疾每为俗工所误，又有喜谈医事，研究不精，孟浪服药以自误。如苏文忠
公事，可惋叹焉。建中靖国元年，公自海外归，年六十六，渡江至仪真，舣舟东海亭下，登
金山妙高台时，公决意归毗陵，复同米元章游西山，逭暑南窗松竹下，时方酷暑，公久在海
外，觉舟中热不可堪，夜辄露坐，复饮冷过度，中夜暴下，至旦惫甚，食黄 粥觉稍适。会
元章约明日为筵，俄瘴毒大作，暴下不止，自是胸膈作胀，却饮食，夜不能寐。十一日发
仪真，十四日疾稍增，十五日热毒转甚，诸药尽却，以参苓瀹汤而气寝止，遂不安枕席，公
与钱济明书云∶某一夜发热不可言，齿间出血如蚯蚓者无数，迨晓乃止，困惫之甚。细察病状
，专是热毒根源不浅，当用清凉药，已令用人参、茯苓、麦门冬三味煮浓汁，渴即少啜之，
余药皆罢也。庄生闻在宥天下，未闻治天下也，三物可谓在宥矣，此而不愈则天也，非吾过
也。二十一日，竟有生意，二十五日疾革，二十七日上燥下寒，气不能支，二十八日公薨。
余按∶病署饮冷暴下，不宜服黄 ，迨误服之。胸胀热壅，牙血泛溢，又不宜服人参、麦门
冬。噫！此岂非为补药所误耶？（近见侯官林孝廉《昌彝射鹰诗话》云∶公当暴下之时，乃阳
气为阴所抑，宜大顺散主之，否则或清暑益气汤、或五苓散、或冷香引子、及二陈汤、或治
中皆可选用，既服黄 粥，邪已内陷，胸作胀以为瘴气大作，误之甚矣，瘴毒亦非黄 粥所
可解，后乃牙龈出血，系前失调达之剂，暑邪内干胃腑，宜甘露饮、犀角地黄主之，乃又服
麦冬饮子及人参、茯苓、麦门冬三物，药不对病，以致伤生，窃为公惜之云云。余谓甘露饮
、犀角地黄汤用之，此病固当。至桂、附等味，公之热毒如是之甚，亦不可用也。）
用药最忌夹杂，一方中有一二味即难见功。戊午季春，余自武林旋里，舟子陈姓病温，
壮热无汗，七日不食，口渴胸痞，咳嗽头痛，脉数，右甚于左，杭医定方，用连翘、栝蒌皮、牛
蒡子、冬桑叶、苦杏仁、黑山栀、象贝、竹叶、芦根，药皆中病，惜多羚羊角、枳壳二味，
服一剂，病不减，胸口闷，热转甚，求余延医，余为去羚羊角、枳壳、加淡豆豉、薄荷，服
一剂，汗出遍体，即身凉能食，复去淡豆豉、牛蒡子，加天花粉，二剂全愈。因思俗治温热
病，动手即用羚羊角、犀角，邪本在肺胃，乃转引之入肝心，轻病致重，职是故耳。
《陶谷清异录》云∶昌黎公愈，晚年颇亲脂粉，故事服食，用硫黄末搅粥饭，啖鸡男，
交千日，烹庖，名火灵库，公间日进一只焉，始亦见功，终致绝命。以HT 按∶白乐天诗中“
退之服硫黄句”，昔人已辨其非昌黎公，陶氏此说，未必可信，然亦足征服食之当谨也。
乩方（通过扶乩获得的药方）的风气，在当今尤为盛行。神仙哪里是专门为人治病的，大抵都是灵验的鬼怪罢了，所以有的有效，有的无效。我亲眼目睹的案例中，京城的章子雅患寒热往来病，乩方用人参、黄芪，结果导致痰液阻塞而死亡。萧山的李仪轩年老足部痿软无力，乩方用附子、熟地黄、羌活、细辛等药物，结果导致失血而亡。那些被这种风气迷惑的人，见效了就说是仙人的灵验，没见效就说这个人本该死掉，这简直是假借仙人的手来害人性命啊。唉！这种人还能跟他们讲道理吗？
药物既能养生，也能伤生，服用药物的人最应该谨慎。秀水的汪焘（字黄孝廉），擅长诗歌书法，又精通医术。道光乙未年，我和他同住在北京库堆胡同，求他治病的人络绎不绝。丙申年正月，汪突然患上身体发热出汗，自认为是阳明经的热邪，适宜用石膏治疗，服了一剂后，热邪反而内陷；出现皮肤冰冷、腹泻、神志昏迷，三天就去世了。医生认为这原本属于桂枝汤证，不应当用石膏来遏制表邪。嵊县的吴鹏飞（字孚轩，明经），在太平县任职，壬寅年六月参加科试，天气酷热，他身体虚弱且事务繁杂，感受邪气很深。到了秋季中旬疾病发作，起初恶寒发热，病势并不严重，绍兴和台州地区的习俗，病人皆饮用姜汤，却不知道感寒适宜喝姜汤，受暑则禁忌喝姜汤，服用了两盏后，暑邪更加炽盛，最终导致无法救治。又有不辨别药品性质而导致误用的，归安人陈龙光从事外科，偶然因牙痛，让儿媳煎石膏汤服用，却误用了白砒霜，咽下后腹部立即剧痛，不久疼痛加剧，询问得知是误服，急忙饮用粪清催吐，昏沉倦怠了几天才安定下来，幸好砒霜汤只喝了半盏，因为味道不同而吐了出来，否则就危险了。我们县陈庄李家的儿子，夏季患霍乱，请医生定好药方，其中有制半夏二钱，恰好药店库存不足，而买药的人多，新来的伙计误把附子给了他，服药后腹部立即剧烈疼痛并发狂，口中流血而死。李家责怪医生，医生说药没有错，一定有其他原因，索要查看药渣，发现里面有附子。于是向官府控告药店，赠送金钱才罢休。
世俗人喜欢服用温热补益的药物，如肉桂、附子、鹿角胶等，老年人尤其严重，认为这些能壮阳，却不知道高龄之人多半阴液亏损，服用这些必然耗损津液、枯竭肾水，反而缩短寿命。我因此受害的人见得太多了。
飞禽走兽都有智能，比如老虎中了箭毒就吃青泥，野猪中了箭毒就吃荠菜，野鸡被鹰抓伤就贴地黄叶，老鼠中了矾毒就饮泥汁，蜘蛛被蜂蜇就用蚯蚓粪掩盖伤口，还知道咬芋根来擦拭，鹳鸟的蛋破了就用漏下的药汁缠绕包裹。医书中记载的这些例子，数不胜数。现在的人不辨别药味，一遇到疾病，就把性命交给庸医之手，轻的病变重，重的致死，也很可悲啊。
凡是服用补剂，应当审视体质是否适宜，不可偏执一端而致祸害。叶天士《景岳全书发挥》中说：沈赤文年少时读书聪明过人，父母疼爱他，即将成婚，合制全鹿丸一料，四个少年分着服用，赤文从冬季服用到初春，忽然浑身疼痛，渐渐腹中块状物疼痛，消瘦不想吃饭，口渴喜欢喝冷冻饮料，后来服用酒蒸大黄丸，排出无数黑块，用水浸泡后，胀大如黑豆，才知道这是全鹿丸所化，没过几天因热极而死。同服的三个少年，一个患喉痹，一个患肛门毒疮，一个患吐血咳嗽，都死了。这就是服用热药的害处。《叶天士医验录》说：黄朗令六月怕冷，身穿厚重的棉皮袍，头戴黑羊皮帽，吃饭时在床前放火炉，饭刚出锅极热，别人不能入口，他却还嫌冷，脉象浮大迟软，按下去细如丝线。这是真火熄灭，阳气全无的症状。他年轻时阳气旺盛，不知道怎么会落到这一步，仔细探究原因，才知道他的父亲误信别人说：天冬、麦冬熬成的膏，年轻人常服最妙。于是将这两味药熬成膏，让他早晚每天服用不间断，服用了三年。天冬寒肺，麦冬寒肾，使得寒性逐渐浸渍入脏腑，阳气日渐微弱。那年春天，渐渐发生潮热，医生投以发散药，热不退，反而汗出不止，渐渐恶寒，医生又投黄连、花粉、丹皮、地骨皮、百合、扁豆、贝母、鳖甲、玉竹之类，以致出现现在的症状。于是为他定方，用人参八钱，附子三钱，肉桂、炮姜各二钱，川椒五分，白术二钱，黄芪三钱，茯苓一钱，当归钱半，川芎七分。服用八剂后，脱去棉衣，食物仍然畏冷，因此用八味丸加减，另用硫黄制成金液丹，共计服用一百天才完全痊愈。这就是服用凉药的害处。爱护子女的人，能不以此为鉴，而谨慎投予补剂吗？
程杏轩治疗汪木工夏季寒热、呕吐腹泻、自汗、头痛。其他医生给予疏表和中药，呕吐腹泻停止，但发热不口渴，形体疲倦懒言，舌苔微黄而润，脉象虚细。根据《内经》所说“脉虚身热，得之伤暑”，因此使用清暑益气汤加减，服一剂后，夜间热更甚，谵语狂躁不安。次日早晨复诊，脉更细，舌苔色紫肉碎，凝有血痕，口渴嗜饮冷水，这一定是热邪内伏未透，应当舍脉从证，改用白虎汤加生地、丹皮、山栀、黄芩、竹叶、灯心草，服药后，周身汗出，谵狂虽定，但神情呆滞手足冰冷，按脉至骨不见（脉伏可与壶仙翁治风热症参考）。闭目不省人事，知道是热厥，舌苔形短而浓，满舌都起紫泡，大如葡萄，并有青黄黑绿杂色罩在上面，告知家属无法医治。其母哀恳拯救，于是让人取紫雪散蜜调涂舌，前方加入犀角、黄连、玄参以清热，金汁、人中黄、银花、绿豆以解毒，另用雪水煎药。厥逆回阳，脉复出，舌泡消苔退，仅余紫色干燥。再服两剂，热净神清，舌色如常。这次诊疗中，程某说自己能在后来审察出阳证似阴，未能察觉前面实证类虚，自责学力未到，大概是因为初用清暑益气汤的错误。因而想到这个汤，最不可轻用，何况是因为伤暑而脉虚，外见汗多口渴等症状，就更不应当使用了。
医家以丸散治病，不可轻信而服用。我们乡里有个患痞块的人，向湖州某医生求治，医生给予丸药服用，痞病好了却变成膨胀而死。又有婴儿患惊风，请某医生治疗，灌服末药不计其数，惊风好了人却痴呆，长大也不愈，这是因为药中多用朱砂的缘故。
世人喜欢服用人参、白术，虚证固然得益，实证正好成为祸害。苏州某官员的母亲，偶然伤食，又感风邪，身体发热不想吃饭，医生因为她年高体虚，在发散药中夹杂人参、白术投予，病情转为危殆。她的内侄某懂医术，刚好从别处回来，诊察她的脉象，并且询问发病的原因，说：“右脉沉数有力，身体虽然疲惫但神气清醒，这是因为伤食之后，被补药所误，应当用峻猛的药攻下。”于是用大黄、槟榔、厚朴、莱菔子之类的药，服一剂病如故。众人怀疑他错了，他说药力未到，又投两剂，泻去积滞无数，病才好。这可以作为随意服用补药的借鉴。
世俗人常说单方外治法，不比内服，可以大胆使用，不知道也有被害的。《续名医类案》记载：一个僧人患疮疥，自己用雄黄、艾叶在被中熏烤，第二天遍体肿胀，皮破水出，饮食不进，投以解毒药不应而死。大概是毒药熏入腹内而散失真气，灾祸如此。又说：我全家生疮，家人也用此方熏之，疮不愈，不久我的孩子出痘，症状极凶险，药不能下咽而死，大概也是受了毒气。我推测所患的是热毒，以热攻热，毒气更加炽盛。所以凡是用药，先应审明阴阳虚实，不能说外治无害而随意尝试。
身躯肥瘦，与利害有什么关系？随郡王子隆身体肥胖，竟然服用芦茄丸来消减。名位升沉，与荣辱有什么关系？寇准得到宰相职位，竟然服用地黄兼吃萝卜。推而言之，服用金丹以求成仙，反而缩短寿命，服用春药以求子嗣，反而伤害生命。这都是追逐末节而忘记根本的人。
鄱阳名医周顺，说古方不可妄用，如《圣惠方》、《千金方》、《外台秘要》，所论述的病原脉象灸法，都不可废弃，但是处方分量，与现在大不相同，不深入研究其旨意的人，千万不要妄用。有人得眼疾，用古方治疗，眼睛竟然突出。又有妇人产病，用《外台秘要》坐导方，反而得了恶露不尽的病，终身不愈。我说方子固然不要妄用，近代流传的单方，更应当慎重选择使用。朱藩眉极少，方士让他服用末子药六七厘，眉毛就可以再生，告诫服药后须避风。服药当晚就有汗，偶然遇到贼兵来到，就在庭院中，等到回家睡觉，大汗不止，几乎亡阳，后来竟然短寿。（见《折肱漫录》。）湖州胡氏的儿子患水肿，服药无效，有人教他用黑鱼一条，放入绿矾腹中，烧灰服用，服后腹部剧痛突然死亡。古方单方，用得恰当，疗效很快，但应当审察病症是否适宜，并且不要用峻厉的药物，这样才有利而无弊。
士大夫不懂医，遇到疾病常被庸医所误，又有喜欢谈论医事，研究不精，鲁莽服药而自误。如苏东坡的事，令人惋惜感叹。建中靖国元年，苏公从海外归来，六十六岁，渡江到仪真，停船在东海亭下，登上金山妙高台时，苏公决意回毗陵，又同米元章游西山，在南窗松竹下避暑，当时正值酷暑，苏公久在海外，觉得舟中热得难以忍受，夜里就露天坐着，又过度饮用冷饮，半夜突然腹泻，到天亮疲惫得很，吃黄芪粥觉得稍舒适。恰逢元章约明天设宴，忽然瘴毒大作，暴泻不止，从此胸膈胀满，拒绝饮食，夜里不能入睡。十一日从仪真出发，十四日病稍加重，十五日热毒转甚，各种药物都拒服，用参苓煮汤喝而气息渐止，于是不能安枕，苏公给钱济明写信说：“我一夜发热不可言说，齿间出血如蚯蚓者无数，直到天亮才停止，困惫之极。仔细考察病状，专是热毒根源不浅，应当用清凉药，已经让人用人参、茯苓、麦门冬三味煮浓汁，渴了就少喝一点，其余药都停了。庄子说‘闻在宥天下，未闻治天下也’，这三味药可以说是‘在宥’了，如果这样还不愈那就是天命，不是我的过错。”二十一日，竟有生机，二十五日病重，二十七日上燥下寒，气不能支，二十八日苏公去世。
我按语：病署因饮冷暴下，不宜服黄芪，却误服了。胸胀热壅，牙血泛溢，又不宜服人参、麦门冬。唉！这难道不是被补药所误吗？（近来见到侯官林孝廉《昌彝射鹰诗话》中说：苏公当暴下之时，乃是阳气为阴所抑，宜大顺散主之，否则或清暑益气汤、或五苓散、或冷香引子、及二陈汤、或治中皆可选用，既服黄芪粥，邪已内陷，胸作胀以为瘴气大作，误之甚矣，瘴毒也不是黄芪粥所能解的，后来牙龈出血，是由于前失调达之剂，暑邪内干胃腑，宜甘露饮、犀角地黄主之，却又服麦冬饮子及人参、茯苓、麦门冬三物，药不对病，以致伤生，我为苏公感到可惜云云。我认为甘露饮、犀角地黄汤用于此病固然合适。至于桂、附等味，苏公的热毒如此严重，也不可再用。）
用药最忌杂乱，一方中有一二味不合即难见功效。戊午年季春，我从杭州回乡，船夫陈某患温病，壮热无汗，七日不食，口渴胸痞，咳嗽头痛，脉数，右甚于左，杭州医生定方，用连翘、栝蒌皮、牛蒡子、冬桑叶、苦杏仁、黑山栀、象贝、竹叶、芦根，药皆对症，可惜多了羚羊角、枳壳两味，服一剂，病不减，胸口闷，热转甚，求我延医，我为去掉羚羊角、枳壳，加淡豆豉、薄荷，服一剂，汗出遍体，即身凉能食，再去淡豆豉、牛蒡子，加天花粉，二剂全愈。因而想到俗治温热病，动手即用羚羊角、犀角，邪本在肺胃，乃转引之入肝心，轻病致重，就是这个缘故。
《陶谷清异录》说：韩愈晚年颇亲近脂粉，所以经常服食，用硫黄末搅粥饭，吃公鸡，交千日，烹庖，名叫火灵库，韩愈每隔一天进一只，开始也见功效，最终导致绝命。以HT按语：白居易诗中“退之服硫黄句”，前人已经辨明其非韩愈，陶氏此说，未必可信，但也足以证明服食应当谨慎。
The trend of obtaining prescriptions through spirit writing (Ji Fang, a divination method for medical advice) is particularly prevalent nowadays. Do immortals really treat human diseases? Mostly, they are just cunning spirits; therefore, some prescriptions work while others do not. Cases I have witnessed personally include: Zhang Ziya from the capital suffered from alternating chills and fever. The spirit-written prescription used Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix), resulting in death due to phlegm obstruction. Li Yixuan from Xiaoshan, an elderly man with flaccidity of the lower limbs, was prescribed Fu Zi (Aconiti Lateralis Radix Preparata), Shu Di Huang (Rehmanniae Radix Preparata), Qiang Huo (Notopterygii Rhizoma et Radix), and Xi Xin (Asari Radix et Rhizoma) via spirit writing, leading to fatal hemorrhage. Those bewitched by this practice attribute efficacy to the immortals' power and failure to the patient's destined death, effectively using immortals as tools to kill. Alas! Can one reason with such people?
Medicines can nourish life but also harm it; those who take them must be extremely cautious. Wang Tao (courtesy name Huang Xiaolian) from Xiushui was skilled in poetry, calligraphy, and medicine. In the Yiwei year of the Daoguang era, he and I resided together in Kudui Hutong, Beijing. Patients seeking his treatment were constantly arriving. In the first month of the Bing Shen year, Wang suddenly developed fever and sweating. Believing it to be Yangming heat pathogen suitable for treatment with Shi Gao (Gypsum Fibrosum), he took one dose. However, the heat sank inward, leading to cold skin, diarrhea, and coma, causing his death within three days. Physicians stated that this originally belonged to a Guizhi Tang (Cinnamon Twig Decoction) pattern and should not have been treated with Shi Gao to suppress the exterior pathogen. Wu Pengfei (courtesy name Fuxuan), a Mingjing scholar from Shengxian, served in Taiping County. During the Ke examination in June of the Renyin year, the weather was extremely hot. His constitution was weak, and he was overworked, leading to deep pathogenic invasion. By mid-autumn, the illness manifested with initial aversion to cold and fever, with mild severity. Local custom in Shaoxing and Taizhou dictated drinking ginger soup for patients. Unaware that while suitable for cold invasion, it is contraindicated for summerheat, he drank two cups, exacerbating the summerheat pathogen, leading to untreatable condition. Another case involved misidentification of herbs: Chen Longguang from Gui'an, a surgeon, suffered from toothache and ordered his daughter-in-law to decoct Shi Gao (Gypsum Fibrosum). Mistakenly, Bai Pi (Realgar or Arsenic Sulfide, context implies arsenic compound here given toxicity) was used. Upon ingestion, severe abdominal pain ensued, worsening rapidly. Realizing the error, he induced vomiting with fecal liquor. He remained prostrate for several days before stabilizing, fortunate that only half a cup was consumed and rejected due to taste difference; otherwise, it would have been fatal. The son of Mr. Li from Chenzhuang in my county contracted cholera in summer. A physician prescribed Ban Xia (Pinelliae Rhizoma Preparata) 2 qian. Due to pharmacy shortage and high demand, a new assistant mistakenly provided Fu Zi (Aconiti Lateralis Radix Preparata). After ingestion, severe abdominal pain, madness, and hematemesis occurred, leading to death. Mr. Li blamed the physician, who claimed the medicine was correct and demanded to see the dregs, finding Fu Zi there. He sued the pharmacy, settling with a bribe.
Secular society favors warm-tonic medicines like Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Preparata), and Lu Jiao Jiao (Colla Cornus Cervi). This is especially true for the elderly, who believe these boost yang. However, most elderly individuals suffer from yin deficiency. Taking these drugs depletes fluids and exhausts kidney water, shortening lifespan. I have seen many harmed by this.
Animals possess intelligence. Tigers eating green mud after being arrow-poisoned, wild boars eating shepherd's purse, pheons applying Rehmannia leaves to eagle wounds, rats drinking muddy water after aluminum sulfate poisoning, spiders covering bee sting wounds with earthworm excrement, mice rubbing taro roots on injuries, and storks wrapping broken eggs with medicinal residue—these examples in medical texts are numerous. Today, people fail to distinguish herb properties. Upon illness, they entrust their lives to incompetent physicians, turning mild cases severe and severe cases fatal. It is truly lamentable.
When taking tonics, one must assess constitutional suitability. Bias leads to disaster. Ye Tianshi's *Commentary on Jingyue Quanshu* records: Shen Chiwen, a brilliant youth, took Quan Lu Wan (Whole Deer Pill) distributed among four youths before marriage. Consuming it from winter to early spring, he developed whole-body pain, abdominal masses, emaciation, anorexia, and craving for cold drinks. Later, Jiuzheng Dahuang Wan (Wine-Steamed Rhubarb Pill) expelled black clumps swelling to the size of black soybeans in water, revealing the transformation of the deer pill. He died of extreme heat days later. The other three youths died of throat bi, anal abscess, and hemoptysis/cough respectively. This illustrates the harm of hot medicines. *Ye Tianshi's Medical Records* states: Huang Langling feared cold in June, wearing heavy cotton-pelt robes and sheepskin hats, keeping a stove by the bed, yet still complaining of cold despite scalding food. His pulse was floating, large, slow, and soft, fine as silk upon pressure. This indicates extinguished true fire and total absence of yang. Investigating his history, his father believed Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix) paste was excellent for youth. Administered morning and night for three years, the cold nature of these herbs infiltrated the zang organs, diminishing yang. Spring brought tidal fever. Dispersing herbs failed; sweating continued. Subsequent use of Huang Lian (Coptidis Rhizoma), Fen Hua (Bambusae Caulis in Taeniam), Mu Dan Pi (Moutan Cortex), Di Gu Pi (Lycii Cortex), Bai He (Lilii Bulbus), Bian Dou (Dolichos Lablab Semen), Bei Mu (Fritillariae Cirrhosae Bulbus), Bie Jia (Testudinis Carapax et Plastrum), and Wei Yu (Polygonati Odorati Rhizoma) worsened the condition. The corrected prescription used Ren Shen (Ginseng Radix) 8 qian, Fu Zi (Aconiti Lateralis Radix Preparata) 3 qian, Rou Gui (Cinnamomi Cortex) and Pao Jiang (Zingiberis Rhizoma Preparatum) 2 qian each, Chuan Jiao (Sichuan Pepper) 5 fen, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 2 qian, Huang Qi (Astragali Radix) 3 qian, Fu Ling (Poria) 1 qian, Dang Gui (Angelicae Sinensis Radix) 1.5 qian, and Chuan Xiong (Ligustici Chuanxiong Rhizoma) 0.7 qian. After eight doses, outer garments were removed, though food intake remained cold-sensitive. Bajun Wan (Eight-Ingredient Pill) modifications and Liu Jin Dan (Golden Liquid Pill) made from Liu Huang (Sulfur) were taken for 100 days until recovery. This demonstrates the harm of cooling medicines. Parents should heed this caution regarding tonics.
Cheng Yanxuan treated carpenter Wang's summer chills/fever, vomiting/diarrhea, spontaneous sweating, and headache. Other doctors used harmonizing exterior-interior formulas. Vomiting/diarrhea stopped, but fever persisted without thirst. The patient was fatigued, spoke little, had a slightly yellow moist tongue coating, and a deficient-thin pulse. Citing *Neijing*: "Deficient pulse with body heat results from summerheat injury," Cheng used Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) modified. One dose worsened night fever, causing delirium and restlessness. Next morning, pulse was thinner, tongue purple with cracked flesh and blood traces, thirsty for cold drinks. Heat pathogen was trapped internally. Discarding pulse diagnosis for symptoms, Cheng switched to Baihu Tang (White Tiger Decoction) plus Sheng Di Huang (Rehmanniae Radix), Mu Dan Pi (Moutan Cortex), Shan Zhi (Gardeniae Fructus), Huang Qin (Scutellariae Radix), Zhu Ye (Bambusae Folium), and Deng Xin Cao (Junci Medulla). Sweating followed, calming delirium, but consciousness was lost, limbs cold, pulse imperceptible at bone depth (compare with Huxianweng's wind-heat case). Eyes closed, unconscious. Diagnosed as heat jue (reversal). Tongue coating short/thick, covered in purple blisters grape-sized, mixed with green/yellow/black colors. Prognosis: terminal. Mother begged for help. Cheng applied Zixue San (Purple Snow Powder) with honey to the tongue, added Xijiao (Rhinocerotis Cornu - now prohibited, substitute Niujiao or similar in modern practice, but text says Xijiao), Huang Lian (Coptidis Rhizoma), Xuanshen (Scrophulariae Radix) to clear heat; Jinzhi (Human Excrement Distillate), Renzhonghuang (Refined Human Excrement), Yin Hua (Lonicerae Japonicae Flos), Lv Dou (Phaseoli Semen) to detoxify. Decocted with snow water. Reversal reversed, pulse returned, blisters subsided, coating receded, leaving dry purple tongue. Two more doses cleared heat and restored clarity. Cheng admitted failing to detect excess syndrome resembling deficiency initially, blaming the initial Qingshu Yiqi Tang. He warned against lightly using this formula, especially with deficient pulse and sweating/thirst signs.
Physicians' pills and powders should not be trusted blindly. A villager treated for pi mass (abdominal lump) by a Huzhou doctor took pills. The mass resolved, but he died of distension. An infant with convulsions was given excessive powder medicine by a doctor. Convulsions stopped, but the child became permanently痴呆 (dull/stupid) due to excessive Zhusha (Cinnabar).
People love Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma). Deficiency benefits; excess harms. A Suzhou official's mother had food stagnation and wind-cold invasion: fever, anorexia. Doctor, citing age and weakness, added Ren Shen and Bai Zhu to dispersing herbs. Condition worsened dangerously. Her nephew, a physician, examined her: right pulse deep, rapid, forceful. Though exhausted, spirit was clear. Diagnosis: food stagnation mistreated by tonics. Required harsh purgation. Used Da Huang (Rhei Radix et Rhizoma), Bing Lang (Arecae Semen), Hou Po (Magnoliae Officinalis Cortex), Laifu Zi (Radish Seed). First dose ineffective. Nephew insisted on potency, added two more doses. Massive stool discharge cured the illness. Lesson: beware of indiscriminate tonic use.
Secular belief holds external single-formula treatments are safer than internal ones. Yet, harm occurs. *Continued Famous Medical Cases* records a monk with sores using Xionghuang (Realgar) and Ai Ye (Artemisiae Argyi Folium) fumigation. Next day, whole body swollen, skin ruptured, fluid oozing, unable to eat. Detoxification failed; he died. Poison entered interior, scattering true qi. Another case: author's family used fumigation for sores; sores didn't heal. Child later died of smallpox with severe symptoms, unable to swallow medicine, likely due to toxic accumulation. The sores were likely heat-toxin; attacking heat with heat intensified it. Always differentiate yin/yang and deficiency/excess before external treatment.
Body fatness/thinness doesn't dictate health risks. Wang Zilong from Suichun was fat but took Luqie Wan (Reed Eggplant Pill) to slim down. Status rise/fall doesn't define honor/disgrace. Kou Zhun (Lord Lai) became chancellor but took Dihuang (Rehmanniae Radix) and ate radishes. Seeking immortality via Golden Elixir shortened life; seeking offspring via aphrodisiacs harmed life. These pursue trivialities while neglecting fundamentals.
Zhou Shun, a famous doctor from Poyang, warned against blind ancient prescription use. While texts like *Shenghui Fang*, *Qianjin Fang*, and *Waitai Miyao* contain valuable pathology/pulse/acupuncture info, dosage differs significantly from modern standards. Without deep study, do not use them arbitrarily. One eye disease patient using ancient formula suffered protruding eyes. A postpartum woman using *Waitai Miyao* suppository formula suffered lochia retention lifelong. Ancient and single formulas can be effective if matched correctly, but avoid harsh drugs.
Scholars lacking medical knowledge are often misled by quacks. Others discuss medicine superficially and harm themselves with rash medication. Example: Su Shi (Su Dongpo). In Jianzhong Jinguo Year 1, aged 66, returning from overseas, he stopped at Yizhen. Climbing Jinshan Miaogao Terrace, deciding to return to Wuling, he toured West Mountain with Mi Yuanzhang. Escaping summer heat under pines/bamboos, he found boat heat unbearable, slept outdoors, drank excessive cold liquids. Midnight sudden diarrhea left him exhausted. Huangqi (Astragali Radix) porridge helped slightly. Mi invited dinner next day. Suddenly, miasma toxin flared, diarrhea continued. Chest fullness, anorexia, insomnia. Departed Yizhen 11th, worsened 14th, severe heat toxin 15th. Refused all meds except Renshen-Fuling soup which calmed breath slightly. Wrote to Qian Jiming: "Night fever unbearable, gums bleeding like earthworms until dawn. Exhausted. Heat toxin root is deep. Should use cooling meds. Ordered Ren Shen, Fu Ling, Maidong (Ophiopogonis Radix) boiled thick, sipped when thirsty. Stopped others. Zhuangzi said 'Hear of governing by non-interference, not treating the world.' These three herbs represent non-interference. If not cured, it is heaven's will." 21st: slight improvement. 25th: critical. 27th: upper dryness, lower cold, breath failing. 28th: died.
My comment: Diarrhea from cold drinks contraindicates Huang Qi. Chest fullness/heat/tooth bleeding contraindicates Ren Shen/Maidong. Wasn't this harm from tonics? (*Changyi Sheying Shihua* by Lin Xiaolian argues: At diarrhea stage, yang suppressed by yin, should use Dashun San or Qingshu Yiqi Tang/Wuling San/Lengxiang Yinzi/Erxun Tang/Zhongman Tang. Huangqi porridge caused pathogen sinking. Chest fullness mistaken for miasma. Gum bleeding due to prior mishandling, summerheat invading stomach. Should use Ganlu Yin or Xijiao Dihuang Tang. Instead, Maidong Yinzi/Ren Shen/Fu Ling/Maidong were used, mismatching disease, causing death. I agree Ganlu Yin/Xijiao Dihuang Tang fits. But Gui/Fu are definitely wrong for such severe heat toxin.)
Medication忌讳 (taboo) mixing incompatible herbs. Even one or two mismatches hinder efficacy. Wuwu year, late spring, returning from Hangzhou, boatman Chen had warm disease: high fever, no sweat, 7 days no food, thirst, chest stuffiness, cough, headache, rapid pulse (right > left). Hangzhou doctor prescribed Lianqiao (Forsythiae Fructus), Gualou Pi (Trichosanthis Pericarpium), Niubang Zi (Arctii Fructus), Dong Sangye (Mori Folium), Ku Xingren (Armeniacae Semen Amarum), Hei Shanzhi (Gardeniae Fructus Charred), Xiangbei (Fritillariae Thunbergii Bulbus), Zhuye (Bambusae Folium), Lugeng (Phragmitis Rhizoma). Herbs matched disease, but included Lingyangjiao (Tauri Cornu) and Zhike (Aurantii Fructus). One dose: no improvement, chest oppression, worse heat. Asked me to consult. I removed Lingyangjiao/Zhike, added Danshichi (Fermented Soybean) and Bohe (Menthae Haplocalycis Herba). One dose: whole body sweating, cool body, appetite returned. Removed Danshichi/Niubang Zi, added Tianhuafen (Trichosanthis Radix). Two doses: cured. Reflection: Common warm-disease treatment uses Lingyangjiao/Xijiao immediately. Pathogen is in Lung/Stomach; these herbs divert pathogen to Liver/Heart, worsening mild cases.
*Tao Gu Qingyi Lu* states: Han Yu (Han Changli) favored cosmetics in old age, frequently ingested sulfur mixed with porridge/rice, ate roosters, processed over 1000 days into "Fire Spirit Warehouse," consuming one every other day. Initially effective, ultimately fatal. HT notes: Bai Juyi's poem "Tuizhi takes sulfur" was previously debunked as not referring to Han Yu. Tao's account may be unreliable, but suffices to warn against reckless ingestion practices.