予六十九岁。七月十三日，先呕，腹响，痛，大泻，泻出如痰甚多，两足麻木拘挛不能开，所贮来复丹、霹雳散、正气丸，自觉于症不符。因记袁子才诗集患此，薛一瓢令服木瓜汤即愈。遂恣饮之，渐愈。叶云扶虚进参附。张石顽先生云：暑症误药，皆有救法。误服附子为难解。曾见有下咽即死者。予救叶协台，诸法不效。然治会稽明府范公之封翁，八月间转筋，用大顺散、参、附、姜、桂得效，大抵治病须辨别确切也。表之汗不易彻。彻，通也，曾见八月间患头痛，头如破，服各表药无效。一朝大汗即痉厥，不治。是犯仲景之戒。盖病属伏暑。上焦当用薄荷、丝瓜叶、竹叶、淡豆豉、葱头，以柴胡、葛根、羌活等杀之也。又见阴虚人，七月间，服小柴胡三四剂，大汗如浴，不救。城乡医者治暑，治暑无不以小柴胡汤，每至久缠不已。即用前法，诸恙悉解。而引入少阳之贼，反寒热不去。予仍用柴胡截之，反致人诘。讵知即仲景附子泻心汤，治误下结胸，内有大黄。喻氏治酒病，仍用酒引。解铃仍用紧铃人也。予治吴又轩，在嘉兴府幕，患上焦症，头痛，身热，无汗，口燥。海盐廪生朱案云：用吴氏条辨法。辛凉微苦，字句书法均妙，而药乃甜杏、甘草、秦艽，与案不符。归家予用叶法，应候乃解，攻之便易溏泻。盖遵河间法，至七八日自能溏泻，为湿邪自化(是得药暑湿分开湿从下化之候)，可接用通溲药，为开支河之法。予遇久患暑湿六七十日，误攻，大便似痢，非痢用叶法即得畅解。譬如群小成聚，一见君子渐散也。过清则支冷呕恶，邪经化火，乌得不以。羚角、川连，清之当中病即止，过剂则支冷呕恶，洞泻，为不治。予曾仿丹溪噤口痢法，以辽参入泻心汤治呕恶；以辽参入扶脾药救洞泻，往往无效。大抵辽参无真者耳。抑虽真亦不治耶。至误服承气，伤脾及胃，作泻，舌雪花，不食，有用参、术、炮姜得愈者。又治胡姓，服承气后大泻，舌鲜红，脱液，口燥欲裂，为肾阴之伤。仿甘露法，二地、二冬、肉桂、茯苓、生米仁、滑石、石斛，泻止津回。又治富合盛伏暑，盲医误下泻水，舌鲜红，脉弦小促，呃从少腹起，响而缓，为伤及肝肾，覆以不治。其父下跪磕头求救。予拟胡姓得效方，适盲医又至，被留，合商。彼诊毕，告予，谓食未净。予曰，乌知其有食曰：若食净，身当凉，不凉，故知其未净。予曰：子食饭，必有食，何以身不热彼所病者，暑湿也，非食也；养人者，食也；杀人者，病也。子何以不治杀人之暑湿，而治养人之食彼不能说，以呃逆为肝气，开旋覆汤而散。呜呼!医若是，亦生人之大不幸也。然而臣门竟如市也，则为不可解之事。嗣病家又邀一医，以犀角地黄汤下咽，即死，亦一盲也。此二人若照《医门法律》，当入无闲地狱。又八月间，治松林老幕师薛朴堂先生之孙，盲医先生已有方，予不知也。诊脉数，舌黑燥，口渴作泻，身热有汗，予案云：此属伏暑，湿邪已化之候，而肺液胃津先涸，当增液通溲。若误作挟热下利，便非治暑湿法。程则根生地、生白芍、麦冬、生米仁、生谷芽、地骨皮、益元散、通草等药。朴堂并不知医，以兴彼之青麟丸、蒌仁、麻子仁、枳壳大异，因曰：天下医，只一理，何冰炭若是请问攻泻何意以彼之不曾立案也。彼云：急下存津，缘不早攻，故致舌黑。今攻之或可救也。又问：夫子何为予曰：予意在案，请观案可也。彼云，能开方，何以不能说予曰：子所言是《伤寒论》，此所患是暑湿症。丹溪先生云，暑湿从无大便攻泻之理。譬如刑名案情，罪轻重不等，岂皆杀耶传曰：山有木，工则度之；宾有礼，主则择之；主人择之可耳。朴堂先生以予言为长，服予方四五剂即愈。又治西郭嘉余典内一妇，伏邪误服大黄致危。予以叶法，多日治愈。身凉能食或食后倾囊吐出，吐后仍食，间数日，又吐。予用仲景炮姜甘草汤，一剂即止。盖炮姜三钱、炙甘四钱，以大黄之伤其胃也。过燥则唇齿燥裂，燥药以苍术为最，厚朴半夏次之；川连苦以燥之，燥亦甚；米仁、滑石、茯苓，虽燥不裂。上焦症，易于化燥，患久须重用根生地两许，多剂救其津液，方可得汗通溲。予治三财殿前朱石翁，患伏暑五六十日，不汗不凉不食不便，用根生地两许，佐以麦冬、元参多剂，始得汗，得（病-丙c咅），且大解而身凉能食。若遇阴津素亏之人，舌净光洁者，尤忌燥药。盖伏暑患在秋时，正当燥令，岂可过剂耶又苍术，本草谓其浴血，凡妇女经后，即遇水泻，万勿加用，用必液涸，虽大剂增液不可救。(元参一两，生地八钱，麦冬五钱，名曰增液汤。凡遇风温、温热、温疫之阴虚不得便者，服三四剂，大便畅解，身亦凉。若用承气，反致液涸难救。)暑湿发（病-丙c咅）者，多夹风者，亦发疹，须托疹。大力子、蝉退、晚蚕沙、木防己等。烦予曾于六月间，遇发斑者，大便必泻，往往不治。当时不过一二人，并非沿门合境，则非瘟疫可知。至今尚未解其何故。暑症最忌指尖怕冷，其人阳气必虚，最易洞泻，用药不可不慎。暑湿有化胀者，当遵《内经》胀起于上焦而甚于下焦而者，当先治其下焦，后治其上焦。治上焦麻黄汤，治下焦五苓散。然予试验，当改云，须始治其上焦而终治其下焦。若用麻黄，必重用生石膏，为大青龙、越婢等法。以麻黄性温，于暑未符也。此予之心得，治愈颇多。又治覆船山俞，六十外年纪，伏暑化胀已月余，不能行走，不能食用，张子和桂苓甘露饮二十余剂，愈。又富阳医者马姓，自述在军营当差，受暑化胀年余，自服金匮肾气不效，慕名求治，予曰：金匮肾气治肾胀，于病不符。暑胀在下焦，当用张子和桂苓甘露饮。所谓桂苓者，古法肉桂一钱五分，泡浓汁，渗入茯苓片六钱，晒干入煎为君，每剂如是，始效耳。乃揖谢曰：不差不差，合好合好。而去，未知其究竟愈否。第无论何胀，切须忌口，荤油面食尤忌，咸味可毋忌，然不可过咸耳。又暑湿有夹疮疡者，治朱水泉世侄，八月间患暑，而湿邪尤重，溏泻，肛门患疮。考{金鉴》云，名鹤口疽。但治其湿，疮当先愈。用生茅术、生冬术、猪苓、茯苓等，果疮先结痂，而后身凉。伏暑有两腿肿胀，浮大酸重，不便行走者，须用木防己、石膏、泽泻、炙桑皮。桑皮须自于桑根上掘取，药铺皆身上剥皮，非下焦药，故无效。又满身患暑湿烂疮，用根生地两许，羚角，连翘、川连、地骨皮、六一散、茯苓皮、晚蚕沙、木防己、泽泻、通草、竹叶，不过十剂，愈。予友某，文理绝通，医名亦有。其家中有患暑，久而未愈，邀治。诊脉合症，是上焦。予曰：治之某日，必愈。是逢每五日为一候之期也用叶法，果至期解。叹以为奇殊。不知渠确遵《准绳》治暑用六经法。叶案未经目也。故予集《医针》一书，各病以一专长者为主。以众说会之，如伤寒以仲景六经法，遵柯韵伯说；诸温邪以河间法，遵张喻吴叶论，及吴氏条辨，肝胃阳虚，遵东垣；肝胃阴虚，遵丹溪；暑湿风温，遵叶氏；诸疝，遵张子和《儒门事亲》书；吐血，遵为缪氏《广笔记》。古人各有专长，吾辈幸生古人之后，当统观而效法之。若坐井观天，曰天在。是天岂尽于是哉!惜风温、温热、瘟疫诸说被人攫去。惟余吐血一篇，嗣以病止，假我数年，若得成功，再当奉正。
又叶氏云：若有所夹，又须变通。予治夹经、夹产，业于温邪热人血室等论及之矣。至治朱石翁郎，十余岁时，九月间患伏暑，已十四日，邀诊。脉弦大，寒热不分，明是阳尚未通，为失治。云，此症变幻有不可言者。用开提中焦法，分离其暑湿，一剂大流鼻衄，以鲜生地、羚角、知母、元参、麦冬、山查花等而解肺分阴阳，则大泻，泻出黑如墨汁，入水则鲜血也。予曰：肺与大肠相表里，仍属肺分，暑毒郁热，前法加减，复以通溲。乃胸痛呕蛔，用椒梅饮，川连多而姜甚少，呕止，睾丸缩入，小腹作痛，囊肿仰卧，不能动，动则腰背痛不可忍。是即叶氏所谓易虚易实之体，病久属虚，以张子和治疝法。补以生地、阿胶，再进虎潜丸法。无如药肆虎骨无真者，终成颓疝。予云：孩年颓疝为终身之累，须于长发时以虎潜丸合当归生姜羊肉汤可断根，曾经治愈多多。乃正在避乱，不及服。至今二十余岁，不常举发。若有真虎胫骨多剂，尚可为也。暑湿解期，以候为期，每五日为一候。非若伤寒温邪之七日为期也。如第四日有凉汗，则第五日解。第十四日有凉汗，则第十五日解。如无凉汗，又须一候矣。若治四五六十日外之暑湿，每逢第五日或第十日解。解之先一日必有凉汗，素有治暑薄名，伎俩不过如是，可谓纯盗虚声。###瘄 子###
绍兴谓之瘩子，苏州谓之沙子，其实皆风，感肺分。叶天士先生云：即属风感肺分，与发疹治法一样耳。当按四时法治之。在冬令发瘩，当用冬温法；夏时用暑风法；秋时用秋燥法；春时用风温法，则当用辛凉法，甘寒法，薄荷、连翘炒、大力子、桔梗、生甘、苦杏仁、麦冬、石膏、知母、玉竹、沙参、细生地、象贝、橘红、金银花、酒黄芩、冬桑叶。或大便作泻，加淡渗法，则生米仁、茯苓，又炒银花最妙。或火盛，则羚角、犀角、丹皮、焦栀子，或用苇茎汤、白虎汤，夏秋用，冬春断不可用桂枝、白虎、竹叶石膏汤，或又加蔗浆、梨皮，各因其轻重而用之。又有入心营则犀角地黄汤，加紫雪或至宝丹。大抵初起大便水泻者，不必服药。大便燥结不通，谓之闷瘠，最危。俗法用西湖柳，性热，《温病条辨》大忌之也。至棉丝绵、樱桃核，不知出于何书。儿科用之可笑也。道光癸卯间五月考时，考客患瘄，儿科用桂枝无不鼻衄。予用辛凉合甘寒无不即愈，而竟不用西湖柳。可见叶法不误人。又若初见怕冷，加荆芥亦可，(荆芥性温，怕冷是寒。)有寒邪故可用。余每用白蔻壳，以躯壳病，故用壳药，去壳寒也。若初起作呕，大力子易于作呕，用之呕更甚。然《内经》在上者，因而越之，风痰呕出，瘄疹出透矣，何妙如之！若怕其呕，加白蔻仁八分，即不呕。又本草，大便泻者，大力子禁用。以大力子能作泻也。然瘄子出，泻者不药可愈，愈泻愈妙。又瘄后水泻，亦不碍，用甘寒复以淡渗，加银花炭最妙。误用温热乃参术，必危，最怕吐血。《医病简要》终
我六十九岁时，七月十三日，先出现呕吐，腹部作响，疼痛，剧烈腹泻，泻出的物质像痰一样非常多，双足麻木、拘挛且无法伸展。当时我存放的来复丹、霹雳散、正气丸，我觉得与病情不符。于是想起袁子才的诗集中记载过此病，薛一瓢让他服用木瓜汤即痊愈。于是我大量饮用木瓜汤，逐渐好转。叶天士曾说扶正需进服人参、附子。张石顽先生也说：暑症误治用药，都有补救方法。但误服附子很难解救，我曾见过有人喝下后立即死亡的案例。我曾救治叶协台，各种方法都不见效。然而治疗会稽范明府的父亲（封翁），八月间发生转筋，使用大顺散、人参、附子、干姜、肉桂而见效。大抵治病必须辨别确切。
表证发汗不容易彻底。彻，就是通的意思，曾见有人在八月间患头痛，头如破痛，服用各种解表药无效。突然大汗淋漓后导致痉厥，不治身亡。这是犯了张仲景的戒律。因为病属伏暑。上焦应当用薄荷、丝瓜叶、竹叶、淡豆豉、葱头，配合柴胡、葛根、羌活等药来清解。又见阴虚之人，七月间服用小柴胡汤三四剂，大汗如雨，不治身亡。城乡医生治疗暑症，无不使用小柴胡汤，往往导致病情缠绵不愈。即使使用前法，诸症悉解，但引入少阳之邪，反而寒热不去。我仍用柴胡截断病势，反而被人责问。岂知这正是张仲景的附子泻心汤，用于治疗误下导致的结胸，方内有大黄。喻嘉言治疗酒病，仍用酒作为药引。解铃还须系铃人。
我治疗吴又轩，他在嘉兴府幕府任职，患上焦症状，头痛，身热，无汗，口燥。海盐廪生朱案说：用吴鞠通的《温病条辨》方法。辛凉微苦，字句书法都很精妙，但药却是甜杏仁、甘草、秦艽，与医案不符。回家后我用叶天士的方法，顺应时令便解除了病症，攻下后大便容易溏泻。这是因为遵循刘河间的法则，到了七八天自然能溏泻，这是湿邪自行化解的表现（这是得药后暑湿分开，湿从下焦化解的征象），可以接着使用通利小便的药物，这是开支河的方法。我遇到久患暑湿六七十天的人，被错误地攻下，大便似痢疾，但不是痢疾，用叶天士的方法就能畅快解出。譬如群小聚集，一见君子就渐渐散去。过度清热则会导致四肢冰冷、呕吐恶心，邪气经过化火，怎么能不用羚羊角、黄连来清热呢？但要中病即止，过量则会导致四肢冰冷、呕吐恶心、洞泄不止，成为不治之症。我曾模仿朱丹溪治疗噤口痢的方法，将辽参加入泻心汤治疗呕吐恶心；将辽参加入健脾药治疗洞泄，往往无效。大抵是因为辽参没有真货吧。即使是真的，难道也不治吗？至于误服承气汤，损伤脾胃，导致腹泻，舌苔如雪花般白滑，不能进食，有用党参、白术、炮姜治愈的案例。
我又治疗一位胡姓患者，服用承气汤后大泻，舌质鲜红，津液枯竭，口燥欲裂，这是肾阴受伤。模仿甘露饮法，用地黄、天冬、麦冬、肉桂、茯苓、生薏苡仁、滑石、石斛，腹泻停止，津液恢复。又治疗富合盛，患伏暑，盲医误下导致泻水，舌质鲜红，脉弦小促，呃逆从少腹起，声响而缓，这是伤及肝肾，覆诊认为难以治愈。他的父亲跪下磕头求救。我拟定胡姓患者有效的方子，恰好盲医又到，被留下商量。他诊脉完毕，告诉我，说病人还有食积未消。我说：怎么知道有食积？他说：如果食积已净，身体应当凉爽，如果不凉爽，所以知道未净。我说：你吃饭，一定有食物，为什么身体不发热？他所患的是暑湿，不是食积；养活人的是食物；杀死人的是疾病。你为什么不去治疗杀人的暑湿，而去治疗养人的食物？他无言以对，以呃逆为肝气郁结，开旋覆代赭汤而散。唉！医生如果是这样，也是病人的大不幸啊。然而医生门前竟像集市一样热闹，这真是不可理解的事。后来病家又请了一位医生，服用犀角地黄汤后咽下，立即死亡，这也是一个盲医。这两个人如果照《医门法律》，应当打入无间地狱。
又在八月间，治疗松林老幕客薛朴堂先生的孙子，盲医已有处方，我不知道。诊脉数，舌黑燥，口渴作泻，身热有汗，我的医案说：这属于伏暑，湿邪已经化热的征象，而肺液胃津先已枯竭，应当增液通利小便。如果误作挟热下利，就不是治疗暑湿的方法。程则根用地黄、生白芍、麦冬、生薏苡仁、生谷芽、地骨皮、益元散、通草等药。朴堂并不懂医，以为这与兴彼的青麟丸、蒌仁、麻子仁、枳壳大相径庭，因而说：天下的医生，只有一个理，为什么冰炭如此不同？请问攻泻是什么意思？因为他不曾立案。他说：急下存津，因为不早攻下，所以导致舌黑。现在攻下或许可以挽救。又问：您为什么不说话？我说：我的意思在医案中，请看医案即可。他说：能开方，为什么不能说？我说：您所说的是《伤寒论》，这里所患的是暑湿症。朱丹溪先生说，暑湿从来没有通过攻下大便的道理。譬如刑名案情，罪轻重不等，难道都处死吗？传曰：山上有树木，工匠就度量它；宾客有礼仪，主人就选择它；主人选择就可以了。朴堂先生认为我的话有道理，服用我的方子四五剂即痊愈。
又治疗西郭嘉余典内的一位妇人，伏邪误服大黄导致危重。我用叶天士的方法，多日后治愈。身体凉爽能进食，或者食后倾囊吐出，吐后仍吃，间隔几天，又吐。我用张仲景的炮姜甘草汤，一剂即止。因为炮姜三钱、炙甘草四钱，是为了修复大黄对胃的伤害。过于燥热则唇齿干燥开裂，燥药中以苍术为最，厚朴、半夏次之；黄连苦以燥之，燥性也很强；薏苡仁、滑石、茯苓，虽然燥但不裂。上焦症状，易于化燥，患病日久须重用根生地一两左右，多剂救其津液，才可以得汗通利小便。我治疗三财殿前朱石翁，患伏暑五六十天，不出汗、不凉、不食、不便，用根生地一两左右，佐以麦冬、玄参多剂，始得出汗，出疹，且大便通畅而身体凉爽能进食。如果遇到阴津素亏之人，舌面光洁者，尤其忌用燥药。因为伏暑发生在秋季，正当燥令，岂可过量用药呢？另外苍术，本草谓其耗血，凡是妇女经后，即使遇到水泻，千万不要加用，用了必然津液枯竭，即使大剂量增液也无法挽救。（玄参一两，生地八钱，麦冬五钱，名叫增液汤。凡遇风温、温热、温疫之阴虚不得大便者，服用三四剂，大便畅解，身体也凉爽。如果用承气汤，反而导致津液枯竭难救。）
暑湿发疹者，多夹风邪，也会发疹，需要托透疹毒。用牛蒡子、蝉蜕、晚蚕沙、木防己等。烦闷的我曾在六月间，遇到发斑者，大便必泻，往往不治。当时不过一二人，并非沿门合境，则可知不是瘟疫。至今尚未解开其中的缘故。暑症最忌讳指尖怕冷，其人阳气必虚，最容易洞泄，用药不可不慎。暑湿有化胀者，应当遵循《内经》“胀起于上焦而甚于下焦”的理论，当先治其下焦，后治其上焦。治上焦用麻黄汤，治下焦用五苓散。但我试验，应当改为：须始治其上焦而终治其下焦。如果用麻黄，必重用生石膏，为大青龙、越婢等法。因为麻黄性温，与暑症不符。这是我的心得，治愈颇多。又治疗覆船山俞某，六十多岁年纪，伏暑化胀已月余，不能行走，不能食用，用张子和的桂苓甘露饮二十余剂，痊愈。又治疗富阳医者马某，自述在军营当差，受暑化胀年余，自服金匮肾气丸不效，慕名求治，我说：金匮肾气丸治肾胀，与病情不符。暑胀在下焦，应当用张子和的桂苓甘露饮。所谓桂苓，古法是肉桂一钱五分，泡浓汁，渗入茯苓片六钱，晒干入煎为君药，每剂如此，才有效。于是拱手谢别说：不错不错，合适合适。然后离去，不知究竟是否痊愈。无论何种胀，切须忌口，荤油面食尤其忌口，咸味可以不忌，但不可过咸。
又暑湿有夹疮疡者，治疗朱水泉世侄，八月间患暑，而湿邪尤重，溏泻，肛门患疮。考《医宗金鉴》云，名叫鹤口疽。但只治疗其湿，疮应当先愈。用生茅术、生冬术、猪苓、茯苓等，果然疮先结痂，而后身体凉爽。伏暑有两腿肿胀，浮大酸重，不便行走者，须用木防己、石膏、泽泻、炙桑皮。桑皮须亲自从桑根上掘取，药铺都是身上剥皮，不是下焦药，所以无效。又满身患暑湿烂疮，用根生地一两左右，羚羊角、连翘、黄连、地骨皮、六一散、茯苓皮、晚蚕沙、木防己、泽泻、通草、竹叶，不过十剂，痊愈。我的朋友某人，文理极通，医名也有。他家中有患暑，久而未愈，邀我治疗。诊脉合症，是上焦。我说：治疗在某日，必定痊愈。这是逢每五日为一候的期数。用叶天士的方法，果然到期限解除。感叹以为神奇。不知道他确实遵循《医学准绳六要》治暑用六经法。叶氏医案未曾看过。所以我集《医针》一书，各病以一专长者为宗主。以众说会之，如伤寒以张仲景六经法，遵循柯韵伯说；诸温邪以刘河间法，遵循张元素、喻嘉言、吴鞠通、叶天士论述，及吴氏《温病条辨》；肝胃阳虚，遵循李东垣；肝胃阴虚，遵循朱丹溪；暑湿风温，遵循叶天士；诸疝，遵循张子和《儒门事亲》书；吐血，遵循缪希雍《广笔记》。古人各有专长，我们幸生古人之后，应当统观而效法之。若坐井观天，说天只在井口那么大。是天岂尽在于此哉！可惜风温、温热、瘟疫诸说被人攫取去。惟余吐血一篇，嗣以病止，假我数年，若得成功，再当奉正。
另外叶天士说：若有所夹杂，又须变通。我治疗夹经、夹产，业已在温邪热入血室等论述中提及了。至治疗朱石翁的儿子，十余岁时，九月间患伏暑，已十四天，邀请诊治。脉弦大，寒热不分，明是阳气尚未通达，为失治。说：此症变幻有不可言者。用开提中焦法，分离其暑湿，一剂大流鼻衄，用鲜生地、羚羊角、知母、玄参、麦冬、山楂花等而解。肺分阴阳，则大泻，泻出黑如墨汁，入水则鲜血也。我说：肺与大肠相表里，仍属肺分，暑毒郁热，前法加减，复以通利小便。乃胸痛呕蛔，用椒梅饮，黄连多而干姜甚少，呕止，睾丸缩入，小腹作痛，囊肿仰卧，不能动，动则腰背痛不可忍。这就是叶天士所谓易虚易实之体，病久属虚，用张子和治疝法。补以生地、阿胶，再进虎潜丸法。无奈药肆虎骨无真者，终成颓疝。我说：孩儿年颓疝为终身之累，须于长发时以虎潜丸合当归生姜羊肉汤可断根，曾经治愈多多。乃正在避乱，不及服。至今二十余岁，不常举发。若有真虎胫骨多剂，尚可为也。暑湿解期，以候为期，每五日为一候。非若伤寒温邪之七日为期也。如第四日有凉汗，则第五日解。第十四日有凉汗，则第十五日解。如无凉汗，又须一候矣。若治四五六十日外之暑湿，每逢第五日或第十日解。解之先一日必有凉汗，素有治暑薄名，伎俩不过如是，可谓纯盗虚声。
###瘄子###
绍兴谓之瘩子，苏州谓之沙子，其实皆风邪感肺分。叶天士先生云：即属风感肺分，与发疹治法一样耳。当按四时法治之。在冬令发瘩，当用冬温法；夏时用暑风法；秋时用秋燥法；春时用风温法，则当用辛凉法，甘寒法，薄荷、连翘炒、牛蒡子、桔梗、生甘草、苦杏仁、麦冬、石膏、知母、玉竹、沙参、细生地、象贝、橘红、金银花、酒黄芩、冬桑叶。或大便作泻，加淡渗法，则生薏苡仁、茯苓，又炒银花最妙。或火盛，则羚羊角、犀角、丹皮、焦栀子，或用苇茎汤、白虎汤，夏秋用，冬春断不可用桂枝、白虎、竹叶石膏汤，或又加蔗浆、梨皮，各因其轻重而用之。又有入心营则犀角地黄汤，加紫雪或至宝丹。大抵初起大便水泻者，不必服药。大便燥结不通，谓之闷瘠，最危。俗法用西湖柳，性热，《温病条辨》大忌之也。至棉丝绵、樱桃核，不知出于何书。儿科用之可笑也。道光癸卯间五月考时，考客患瘄，儿科用桂枝无不鼻衄。我用辛凉合甘寒无不即愈，而竟不用西湖柳。可见叶法不误人。又若初见怕冷，加荆芥亦可，（荆芥性温，怕冷是寒。）有寒邪故可用。余每用白蔻壳，以躯壳病，故用壳药，去壳寒也。若初起作呕，牛蒡子易于作呕，用之呕更甚。然《内经》在上者，因而越之，风痰呕出，瘄疹出透矣，何妙如之！若怕其呕，加白蔻仁八分，即不呕。又本草，大便泻者，牛蒡子禁用。以牛蒡子能作泻也。然瘄子出，泻者不药可愈，愈泻愈妙。又瘄后水泻，亦不碍，用甘寒复以淡渗，加银花炭最妙。误用温热乃参术，必危，最怕吐血。《医病简要》终
At the age of sixty-nine, on July 13th, I first experienced vomiting, abdominal rumbling, pain, and severe diarrhea. The discharged material was profuse and resembled phlegm. My two feet became numb, cramped, and unable to extend. The Laifu Dan (Reviving Pill), Pili San (Thunderbolt Powder), and Zhengqi Wan (Righteous Qi Pill) that I had stored seemed inconsistent with my condition. Recalling a case recorded in Yuan Zicai's poetry collection where Xue Yipiao cured it with Mugua Tang (Quince Decoction), I drank it freely and gradually recovered. Ye Tianshi once stated that supporting deficiency requires administering Renshen (Ginseng) and Fuzi (Aconite). Mr. Zhang Shiwang also said: For summerheat disorders treated incorrectly, there are always remedial methods. However, accidental ingestion of Fuzi is difficult to resolve; I have seen cases where death occurred immediately after swallowing. I once treated General Ye Xietai, but various methods were ineffective. Nevertheless, when treating the father of Magistrate Fan of Kuaiji in August, who suffered from muscle cramps (Zhuanjin), Da Shun San (Great Harmony Powder) combined with Renshen, Fuzi, Shengjiang (Dried Ginger), and Rougui (Cinnamon Bark) proved effective. Generally, treating diseases requires precise differentiation.
Releasing the exterior through sweating is not easily thorough. "Che" means penetrating. I once saw a patient in August suffering from headache, feeling as if the head were broken, who took various exterior-releasing medicines without effect. Suddenly experiencing profuse sweating led to convulsions and syncope, resulting in untreatable death. This violated Zhongjing's warnings. The disease belonged to latent summerheat. For the Upper Jiao, one should use Bohe (Mint), Siguye (Luffa Leaf), Zhuye (Bamboo Leaf), Danshichidou (Fermented Soybean), and Congtou (Scallion Head), combined with Chaihu (Bupleurum), Gegen (Kudzu Root), and Qianghuo (Notopterygium) to clear it. I also observed a yin-deficient person who, in July, took Xiaochaihu Tang (Minor Bupleurum Decoction) for three or four doses, resulting in profuse sweating like bathing, which was untreatable. Physicians in cities and villages treat summerheat invariably with Xiaochaihu Tang, often leading to lingering illness. Even if previous methods resolve symptoms, introducing pathogenic factors into the Shaoyang may cause persistent chills and fever. I still used Chaihu to intercept the pathogen, yet was questioned by others. Little did they know this resembles Zhongjing's Fuzi Xiexin Tang (Aconite Draining the Epigastrium Decoction), used for chest fullness due to mistaken purgation, containing Dahuang (Rhubarb). Yu Jiayan treated alcoholism using wine as a guide. As the saying goes, he who tied the bell must untie it.
I treated Wu Youxuan, serving in the Jiaxing Prefecture office, who presented with Upper Jiao symptoms: headache, fever, absence of sweat, and dry mouth. Zhu An, a government-sponsored student from Haiyan, suggested using Wu Jutong's *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) method. While the text was exquisite, the prescribed herbs—Tianxingren (Sweet Almond), Gancao (Licorice), and Qinjiao (Gentian)—did not match the case. Upon returning home, I applied Ye Tianshi's method, resolving the condition according to the season. Purging led to loose stools. This followed Hejian's principles: by the seventh or eighth day, natural loose stools indicate self-resolution of dampness (a sign that summerheat and dampness are separating, with dampness transforming downward). One can then use diuretics to open the "side rivers." I encountered patients with chronic summerheat-dampness lasting 60-70 days, mistakenly purged, presenting with dysentery-like stools but not actual dysentery. Using Ye's method allowed for smooth evacuation. It is like petty people gathering; upon seeing a gentleman, they disperse. Over-clearing leads to cold limbs and vomiting; evil transforming into fire requires Lingyangjiao (Antelope Horn) and Huanglian (Coptis), but must stop once the disease is addressed. Overdose causes cold limbs, vomiting, and profuse diarrhea, becoming untreatable. I once imitated Danxi's method for anorectic dysentery, adding Liaoshen (Manchurian Ginseng) to Xiexin Tang for vomiting, and to Piwei (Spleen-Supporting) medicine for diarrhea, often without success. Mostly, Liaoshen lacks authenticity. Even if authentic, does it fail? Regarding mistaken ingestion of Chengqi Tang damaging the spleen and stomach, causing diarrhea, snow-white tongue coating, and anorexia, some recovered with Renshen, Baizhu (Atractylodes), and Paojiang (Roasted Ginger).
I treated a Hu family member who, after taking Chengqi Tang, suffered profuse diarrhea, bright red tongue, fluid depletion, and cracked dry mouth, indicating Kidney Yin injury. Mimicking Ganlu Yin (Sweet Dew Drink), I used Dihuang (Rehmannia), Dongdong (Asparagus and Ophiopogon), Rougui, Fuling (Poria), Sheng Yiyiren (Coix Seed), Huashi (Talc), and Shihu (Dendrobium). Diarrhea stopped, and fluids returned. I also treated Fu Hesheng with latent summerheat; a blind doctor mistakenly purged him, causing watery diarrhea, bright red tongue, wiry-small-rapid pulse, and hiccups rising from the lower abdomen, indicating Liver-Kidney damage, deemed untreatable. His father knelt begging for help. I proposed the formula effective for Hu, just as the blind doctor arrived. After diagnosis, the blind doctor claimed undigested food remained. I asked how he knew. He replied, "If food were cleared, the body would be cool; since it is not, food remains." I countered, "You eat rice; why is your body not hot? Your disease is summerheat-dampness, not food. Food nourishes; disease kills. Why treat the nourisher instead of the killer?" He could not answer, attributing hiccups to Liver Qi stagnation, prescribing Xuanfu Daizhe Tang (Inula and Hematitum Decoction). Alas! Such physicians bring great misfortune to patients. Yet their doors resemble markets, incomprehensible. Later, another doctor prescribed Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction); the patient died instantly. Another blind doctor. According to *Yimen Falv* (Medical Laws), both deserve hell.
In August, I treated the grandson of Old Scholar Xue Putang. A blind doctor had already prescribed medication, unknown to me. Pulse was rapid; tongue black and dry; thirst with diarrhea; fever with sweat. My record stated: Latent summerheat, dampness transformed, Lung fluids and Stomach juices depleted. Must increase fluids and promote urination. Mistaking it for heat-carrying diarrhea is incorrect for summerheat-dampness. Cheng Gen used Dihuang, Baishao (White Peony), Maidong (Ophiopogon), Yiyiren, Guya (Sprouted Grain), Gupi (Dogwood), Yiyuan San (Origin Source Powder), and Tongcao (Akebia). Putang,不懂医, compared it unfavorably to Qinglin Wan and other laxatives, asking why such disparity. The blind doctor claimed "urgent purging to preserve fluids," blaming delayed action for the black tongue. When asked why he didn't speak, I explained his theory applied to *Shanghan Lun*, whereas this was summerheat-dampness. Danxi stated summerheat-dampness never requires purging bowels. Like legal cases, crimes vary; not all warrant death. Putang agreed with me, recovering after 4-5 doses.
I treated a woman in the Xiguo household whose latent pathogen worsened due to mistaken Dahuang use. Ye's method cured her over many days. She could eat when cool, but vomited everything shortly after eating, recurring every few days. I used Zhongjing's Paojiang Gancao Tang (Roasted Ginger and Licorice Decoction): Paojiang 3 qian, Zhigancao 4 qian, to repair Stomach damage from Dahuang. Excessive dryness cracks lips/teeth; Cangzhu (Atractylodes) is most drying, followed by Houpo (Magnolia Bark) and Banxia (Pinellia). Huanglian is bitter-drying; Yiyiren, Huashi, Fuling are less drying. Upper Jiao symptoms easily dry out; long-standing cases require heavy Sheng Dihuang (Fresh Rehmannia), Maidong, Xuanshen (Scrophularia) to restore fluids before sweating/diuresis is possible. I treated Zhu Shiweng with latent summerheat for 50-60 days, no sweat, no cooling, anorexia, constipation. Heavy Sheng Dihuang with Maidong and Xuanshen induced sweat, rash, bowel movement, and cooling/appetite. Yin-deficient patients with clean tongues must avoid drying herbs, especially in autumn's dry season. Cangzhu consumes blood; avoid in post-menstrual women even with diarrhea, or fluids deplete irreversibly. (Xuanshen 1 liang, Dihuang 8 qian, Maidong 5 qian = Zengye Tang. For warm diseases with yin-deficiency constipation, 3-4 doses yield smooth stool and cooling. Chengqi Tang causes irreversible fluid depletion.)
Summerheat-dampness rashes often involve wind; need to vent the rash using Niubangzi (Arctium), Chantui (Cicada Slough), Wancansha (Silkworm Sand), and Mufangji (Stephania). In June, I saw spotted fever with diarrhea, often fatal, but isolated cases, not epidemic. Summerheat strictly forbids cold fingertips, indicating Yang deficiency and risk of profuse diarrhea. If summerheat transforms into distension, follow *Neijing*: treat Lower Jiao first, then Upper Jiao. Upper Jiao uses Mahuang Tang (Ephedra Decoction); Lower Jiao uses Wuling San (Five-Ingredient Powder with Poria). However, my experience suggests treating Upper Jiao first, then Lower Jiao. If using Mahuang, heavily combine with Sheng Shigao (Gypsum), akin to Da Qinglong Tang or Yuebi Tang, because Mahuang is warm and unsuitable for summerheat. This is my insight, yielding many cures. I treated Yu from Fuchuan Mountain, over 60, with summerheat-distension for a month, unable to walk/eat. Zhang Hezi's Guiling Ganlu Yin cured him in 20+ doses. Ma, a physician from Fuyang, served in the military, suffered summerheat-distension for a year, failed Jin Gui Shen Qi Wan. I advised Guiling Ganlu Yin, specifically preparing Rougui (Cinnamon) infusion soaked into Fuling slices. He thanked me and left; outcome unknown. Regardless of distension type, avoid meat/oil/flour; salt is okay in moderation.
Summerheat-dampness with sores: Treated nephew Zhu Shuiquan in August with heavy dampness, loose stools, and anal abscess (He Kou Ju per *Yizong Jinjian*). Treating dampness alone healed the sore first. Used Sheng Maohu, Sheng Dongzhu, Zhuling, Fuling. Sore scabbed, then body cooled. Latent summerheat with swollen, heavy legs requires Mufangji, Shigao, Zexie (Alisma), and Zhi Sangpi (Roasted Mulberry Bark). Use bark dug from roots, not shop-bought, for Lower Jiao efficacy. Full-body summerheat-dampness ulcers cured in 10 doses with Sheng Dihuang, Lingyangjiao, Lianqiao (Forsythia), Huanglian, Digupi (Lycium Bark), Liuyi San, Fuling Pi, Wancansha, Mufangji, Zexie, Tongcao, Zhuye.
My friend, literate and skilled, invited me to treat his family's chronic summerheat. Diagnosis indicated Upper Jiao. I predicted recovery on a specific date based on the five-day *hou* cycle. Ye's method worked. He followed *Zhunseng* six-channel theory, unaware of Ye's records. Thus, I compiled *Yizhen*, focusing on specialists: Zhongjing for Shanghan; Hejian/Zhang/Yu/Wu/Ye for Warm Pathogens; Dongyuan for Liver/Stomach Yang Deficiency; Danxi for Yin Deficiency; Ye for Summerheat-Dampness-Wind; Zhang Hezi for Hernias; Miu for Hematemesis. Ancients had specialties; we should emulate them comprehensively. Sitting in a well limits vision. Sadly, theories on Wind-Warmth and Plague were appropriated. Only my hematemesis chapter remains. With time, I hope to perfect it.
Ye Tianshi noted: If complications exist, adjust treatment. I discussed menstrual/postpartum complications and Heat entering Blood Chamber elsewhere. Treating Zhu Shiweng's son (10+ years old) in September with latent summerheat (14 days): Pulse wiry-large, chills/fever indistinguishable, Yang blocked. Mismanaged. I used Middle Jiao lifting to separate summerheat-dampness. One dose caused massive epistaxis. Resolved with Xian Dihuang, Lingyangjiao, Zhimu, Xuanshen, Maidong, Shanzhahua (Hawthorn Flower). Lung Yin/Yang balance led to profuse black diarrhea (blood in water). Lung-Large Intestine relationship maintained. Added diuretics. Chest pain and vomiting of roundworms treated with Jiaomei Yin (Pepper and Plum Decoction), more Huanglian, little Jiang. Vomiting stopped, testicles retracted, lower abdominal pain, scrotal swelling, inability to move without back pain. This is Ye's "easy to become deficient/excess" constitution, chronic deficiency. Used Zhang Hezi's hernia method, tonifying with Dihuang, Ejiao, then Huyan Wan (Tiger Knee Pill). Fake tiger bone led to permanent hernia. I advised combining Huyan Wan with Danggui Shengjiang Yangrou Tang at hair growth for cure, but war prevented administration. Now 20+, rarely recurs. Authentic tiger bone could help.
Summerheat resolution follows the *hou* (5-day period), unlike Shanghan's 7 days. Cooling sweat on Day 4 resolves on Day 5; Day 14 on Day 15. No sweat extends the period. Chronic cases resolve on Days 5 or 10. Pre-resolve cooling sweat is key. Claims of expertise are often hollow.
### Measles ###
Known as 'Dazi' in Shaoxing, 'Shazi' in Suzhou, essentially Wind affecting the Lung. Ye Tianshi equated it to rash treatment. Treat according to seasons: Winter-Warmth, Summer-Wind, Autumn-Dryness, Spring-Wind-Warmth. Use Xinliang (Acrid-Cool) and Gahan (Sweet-Cold) methods: Bohe, Lianqiao (Forsythia), Niubangzi, Jiegeng (Platycodon), Sheng Gancao, Ku Xingren (Bitter Almond), Maidong, Shigao, Zhimu, Yuzhu (Polygonatum), Shashen (Glehnia), Xi Shengdihuang, Xiangbei (Fritillaria), Juhong (Tangerine Peel), Jinyinhua (Honeysuckle), Jiu Huangqin (Wine-fried Scutellaria), Dong Sangye (Mulberry Leaf). If diarrhea, add Danshen (Light Leaching): Sheng Yiyiren, Fuling. Fried Jinyinhua is best. If Fire excess, Lingyangjiao, Xijiao (Rhino Horn - note: banned now, use substitutes), Mudanpi (Moutan), Jiao Zhizi (Charred Gardenia), or Weijing Tang or Baihu Tang (for Summer/Autumn only). Never use Guizhi (Cinnamon Twig), Baihu, or Zhuye Shigao Tang in Winter/Spring. Add Sugarcane juice or Pear skin based on severity. If entering Ying Level, Xijiao Dihuang Tang plus Zixue (Purple Snow) or Zhibao Dan (Precious Treasure Pill). Initial watery diarrhea needs no medicine. Dry constipation ("Men Mai") is critical. Folk remedy West Lake Willow is hot and contraindicated in *Wenbing Tiaobian*. Cotton silk/cherry pits in pediatrics are absurd. During Daoguang era exams, pediatricians using Guizhi caused nosebleeds. My Xinliang-Gahan cured all without West Lake Willow. Ye's method is safe. If initial chills, add Jingjie (Schizonepeta) due to its warmth against cold pathogens. I use Baokouke (Cardamom Husk) for shell-related issues to remove cold. If vomiting initially, Niubangzi may worsen it. But *Neijing* says "above, induce vomiting"; expelling wind-phlegm helps measles erupt beautifully. To prevent vomiting, add Baokou Ren (Cardamom Seed). Materia Medica forbids Niubangzi in diarrhea, but measles eruption with diarrhea heals better with more diarrhea. Post-measles diarrhea is manageable with Gahan + Danshen + Charred Jinyinhua. Mistakenly using warm Tonics (Renshen, Baizhu) causes danger, especially hematemesis. End of *Yibing Jianyao*.