罗谦甫治建康道周卿子。年二十三。至元戊寅春间。病发热肌肉消瘦。四肢困倦。嗜卧
盗汗。大便溏多。肠鸣。不思饮食。舌不知味。懒言。时来时去。约半载余。罗诊脉浮数
按之无力。正应浮脉歌云。脏中积冷营中热。欲得生津要补虚。先灸中脘。乃胃之纪也。
使引清气上行。肥腠理。又灸气海。使生发元气。滋荣百脉。长养肌肉。又灸三里。乃胃之
合穴。亦助胃气。撤上热使下于阴分。以甘寒之剂泻火热。佐以甘温养其中气。又食粳米羊
肉之类。固其胃气。戒以慎言语。节饮食。惩忿窒欲。病日减。数月后。气得平复。逮二年
肥甚倍常。或曰。世医治虚劳病。多用苦寒之剂。君用甘寒。羊肉助发热。人皆忌之。而
君反令食。何也。罗曰。内经云。火位之主。其泻以甘。藏气法时论云。心苦缓。急食酸以
收之。以甘泻之。泻热补气。非甘寒不可。若以苦寒泻其土。使脾土愈虚。火邪愈甚矣。
又云。形不足者。温之以气。精不足者。补之以味。劳者温之。损者益之。补可去弱。人参
羊肉之类是也。人参能补气虚。羊肉能补血虚。食羊肉何疑耶。
震按罗公治总管史侯男便血。乃运使崔君长子心脾痛。皆灸此三穴。所讲灸穴之义亦同
想其以此取效多矣。柳公度言。予旧多病。常苦气短。因灸气海。气遂不促。自是每岁须
一二次灸之。以气怯故也。合观两家之说。则虚损病用药难效。莫如用灸。扁鹊新书载绍兴
间。有步卒王超。本太原人。后入重湖为盗。年至九十。精彩腴润。能日淫十女不衰。岳阳
民家多受其害。后被擒。临刑。监官问曰。汝有异术。信乎。曰无也。惟火力耳。每夏秋之
交。即灼关元千炷。久久不畏寒暑。累日不饥。至今脐下一块。如火之暖。岂不闻土成砖。
木成灰。千年不朽。皆火之力也。死后。刑官令剖其腹之暖处。得一块非肉非骨。凝然如石
即艾火之效。故云。保命之法。灼艾第一。窃思灼艾而至千炷。惟能忍人之所不能忍。斯
能为人之所不能为耳。亦殊难矣。
丹溪治一老人。七十九岁。头目昏眩而重。手足无力。吐痰相续。左脉散大而缓。右脉
缓大不及左。重按皆无力。饮食略减而微渴。大便四日始一行。医投风药。朱曰。若用风药
至春必死。此大虚证。宜大补之。以参、 、归、芍、白术、陈皮浓煎。下连柏丸三十粒
服一年后。精力如丁年。连柏丸用姜汁炒。姜汁糊丸。
震按脉缓大。重按无力。参、 、术是矣。连柏丸何耶。岂以其微渴大便四日一行耶。
或以脉缓大为热耶。
又治一人。肥大苍浓。因浓味致消渴。投寒凉药。愈后。吃黄雌鸡滋补。约至千只。患
膈满呕吐。医投丁、沉、附子之剂。百帖而愈。值大热中。尚恶风。怕地气。乃堆糠铺簟蔽
风而处。动止呼吸言语皆不能。丹溪诊之。脉四至。浮大而虚。此内有湿痰。以多服燥热药
致气散血耗。当夏令。去当死。赖色苍浓。胃气尚在。以参、 、术熬膏。煎淡五味子汤
入竹沥调服。三日诸证悉除。令其绝肉味。月余平复。因多啖鸡卵。患胸腹膨胀。自用二
陈汤加香附、白豆蔻。其满顿除。乃令绝肉味。勿药自安。
震按动止呼吸言语皆不能。其虚象尚易视。热天畏风怕地气。脉又四至。人必仍视为寒
丹溪断为湿痰者。盖推前因之食鸡千只膈满呕吐而悟之。至谓虚寒之象。以多服燥热药气散
血耗所致。见识高人百倍。用参、 、术煎膏。与脉浮大而虚恰合。其消痰药只用一味。妙
绝。淡五味子汤送者。五味以收其气之散。淡则味薄。兼濡其血之耗也。且用于暑月为更宜
究因选药。巧不可及。令绝肉味善后。尤佳。
吴球治一贵宦。年七十。少患虚损。好服补剂。一日事不遂意。头目眩晕。精神短少。
遂告医以居常多服人参。其效甚速。乃竞用人参熟地汤药。及固本丸并进。反加气急。吴诊
其脉大力薄。兼问病情。因得之曰。先生归休意切。当道苦留。抑郁而致病耳。医者不审同
病异名同脉异经之说。气郁而概行补药。所以病日加也。宦者曰。斯言深中予病。竟用四七
汤数剂宽快而愈。
震按此老原系虚证。后之加剧者。由于郁耳。用补而病转增。自当寻其别因。只缘脉
大力薄。仍属虚脉。故须问而知之也。
虞恒德治一人。年三十岁。三月间。房事后乘马渡河。遇深渊沉没。幸马健无事。连湿
衣行十五里抵家。次日憎寒壮热。肢节烦疼。似疟非疟之状。医作虚证治而补气血。月余不
效。更医作瘵治。用四物加知、柏、地骨皮之类。及大补阴丸倍加紫河车。服至九月。反加
满闷不食。顾乳妪日饮乳汁四五杯。粒米不食。虞诊视六脉皆洪缓。重按若牢。右手为甚。
虞作湿郁治。用平胃散倍加苍术、白术、苓、半、川芎、香附、木通、砂仁、羌、防。加姜
煎服。黄昏一帖。一更时又一帖。至半夜。遍身发红丹如瘾疹。片时遂没而大汗。即食稀粥
二碗。由是诸病皆减。能食。仍与前方服三帖。后以茯苓渗湿汤倍加白术。服二十帖而安。
震按溺水不换湿衣。又值远途。次日即病。何至遂以虚损治。盖庸医着眼在房事后耳。
延至半年。病势益重。而其脉仍非虚损脉。故以湿郁治即愈。合上二案并观之。可见病因亦
汪石山治一人。年逾三十。神色清减。初以伤寒过汗。嗣后两足时冷。身常恶寒。能食
易饥。日见消瘦。频频梦遗。筋骨疼痛。久卧枕榻。医用滋阴降火罔效。汪视左脉浮虚而缓
右脉浮弦而缓。乃曰。足冷身寒。是阳虚之验。又汗多亡阳。奈何以阴虚治。食则易饥者
非阴虚火动也。盖脾胃以气为主。气属阳。脾胃之阳已虚。又泻以苦寒属阴之药。故阳愈
虚而内空竭。须假谷气以扶助之。是以易饥而欲食。虽食亦不生肌肉也。经曰。饮食自倍。
肠胃乃伤。又曰。饮食不为肌肤。其此之谓欤。梦遗亦非特阴虚。经曰。阳气者。精则养神
柔则养筋。今养气虚不能养神。则梦寐弗宁而神弗藏于心。不能养筋。则筋骨疼痛而魂弗
藏于肝。神魂失所。安得不遗乎。经曰。气固形实。阳虚则不能固。而精门失守。此遗之所
以频而不禁也。经曰。肾者胃之关也。今若助阳以使其固。养胃以守其关。何虑遗之不止。
乃以参、 各二钱。白术一钱。甘草五分。枳实、香附、山楂、韭子各五分。煎服半载。随
时令寒暄升降。而易其佐使。遂全安。
震按以上诸案。皆与今之所谓损怯者不同。故亦无用滋阴润肺药者。下条则全似今之损
怯。而用药却平正可法。
又一人年逾三十。质弱而色苍。初觉右耳时或冷气呵呵如箭出。越两月余。左耳气出如右。
早则声哑。胸前有块攒热。晨后声哑稍开。攒热暂息。少间攒热复尔。或嗽恶酸水。小溲频
赤。大便溏泄。虽睡熟。亦被嗽而寤。哕恶二三声。胸腹作胀。头脑昏痛不堪。时或发热。
浑身疼痛。天明前证少息。惟攒热勿休。且近来午后背甚觉寒。两腿麻冷。用参二钱五分。
茯苓、门冬、白术各一钱。黄连、甘草、枳实各五分。贝母、归身各一钱。白芍八分。煎服
江应宿治祁门人周三。年近三十。潮热咳嗽咽哑。诊之。六脉弦数。周故以酒豪。先年
以醉后呕血数升。遂咳不止。百治不应。肌食降序。烦躁喘满。江与四物换生地。加贝母、
丹皮、麦冬、五味、阿胶煎服。加蔗浆一小杯。姜汁少许。嗽渐止。食少。再加白术、茯苓
人参。食渐进。夜噙太平丸。晨服六味合生脉。加枸杞为丸。两月嗽止。半年肥白如初。
震按此条纯是今人治损怯法。两月嗽止。半年全愈。亦颇有之。但不能尽如是耳。
李士材治福建何金阳令郎。患虚损梦遗盗汗。羸顿已极。检其所服。以四物、知、柏为
主。芩、连、二冬为加减。诊其脉大而数。按之极软。李曰。中气大寒。反为药苦矣。乃以
归脾汤。入肉桂一钱。人参五钱。当晚得熟寐。居十日而汗止精藏。更以还少丹兼进。补中
益气间服。一月而瘥。
震按脉大而数。按之极软。诚宜温补矣。然用温补。得数脉退则愈。数脉不退则仍不愈
也。亦惟大而数。按之极软。故可温补。若细而数。按之极软。死期已近。温补何益也。
又治刑部主政唐名必。劳心太过。因食海鲜吐血。有痰。喉间如鲠。日晡烦热。喜其六
脉不数。惟左寸涩而细。右关大而软。思虑伤心脾也。以归脾汤大料。加丹皮、麦冬、生地
二十剂而证减六七。兼服六味丸三月。遂不复发。
吴门张饮光发热干咳。呼吸喘急。服苏子降气。不应。服八味丸。喘益急。迎士材视之
两颊俱赤。六脉数大。曰。此肺肝蕴热也。以逍遥散用牡丹皮一两。苡仁五钱。兰叶三钱
连进二剂而喘顿止。以地黄丸料用麦冬、五味煎膏。及龟胶为丸。至十斤而康。
震按上条于左寸右关。得其病因。此条以服温纳不应。悟其病因。上条喜脉之不数。此
条喜脉之数大。盖二人俱系新病。一虚一实。尚易辨耳。
又曰。南都许轮所孙女。吐血痰嗽。六月诊之。两尺如烂绵。两寸大而数。余谓金以火
为仇。肺不浮涩。反得洪大。贼脉见矣。秋令可忧。八月初五复诊之。肺之洪者变为细数。
肾之软者变为疾劲。余曰。岁在戊午。少阴司天。两尺不应。今尺当不应而反大。寸当
而反沉细。尺寸反者死。肺至悬绝。十二日死。计其期。当死于十六日。然能食者过期。况
十六十七二日。皆金未遽绝也。十八日交寒露。又值火日。经曰。手太阴气绝。丙日笃。丁
日死。言火日也。寅时乃气血注肺之时。不能注则绝。必死于十八日寅时矣。轮所以其能食
未深信也。至十八。果未晓而终。
震按此真入理深谈。粗心者那得如是通盘打算。
侍御冯五玉令爱。发热咳嗽。已及半载。十月间。吐鲜血甚多。每日只食稀粥一盏。大
肉消陷。大便溏泄。沉困着床。脉来七至。李曰。法在不救。人所共知。若能惟余是听。不
为旁挠。可救十中之一。每帖用人参五钱。桂、附各一钱。 、术三钱。归、芍二钱。陈皮
一钱。日投三帖。约进七十剂。及壮水丸三斤。而后起于床。又三月而饮食如旧矣。
震按昔贤治虚劳。每以参、术、桂、附奏奇功。遂诋丹溪滋阴药不可用。深斥苦寒之非
此亦矫枉过正。余亲见吐血能进人参者。日服二三钱。甚相安。不旋踵而血仍吐。益加参
亦复吐。不半年死。又见以参汤送八味丸者。初若效。后则咽痛热甚。不得不停矣。上条
乃必死之证。而用参五钱。桂、附各一钱。日进三帖。殊难信。然能日进三帖。至七十剂。
孙东宿治张子心弱冠病瘵。其证咳嗽。下午热从两足心起。渐至头面。夜半乃退。面色
青。形羸气促。交睫即梦遗。奄奄一息。孙诊其脉。左寸短弱。右关略弦。余皆洪大。因许
可治。病者曰。医皆谓火起九泉者死。大肉尽削者死。咳嗽加汗者死。脉不为汗衰者死。况
当夏令。肺金将绝。先生独言可治。何也。孙曰。证虽危。色声脉三者尚有生意。两颧不赤
心火未焚也。声音不哑。肺金未痿也。耳叶不焦。肾水未涸也。据面青者忧疑不决。左寸
短者心神不足。关略弦者谋为不遂。必因志愿高而不称其心。谋为而不遂其欲。殆心病。非
肾病也。经曰。色脉相得者生。故许可治。病者恍然曰。是矣。予因星士决上科必售。予仍
落第。而同窗者中。故怏怏至此。今亦忘其病源矣。乃为定方。以人参、枣仁、龙骨为君。
丹参、石斛、贝母、麦冬、五味子为臣。山栀、香附为佐。二十帖而病起。丸方则人参、麦
冬、五味、熟地、枸杞、龟板、茯苓。蜜丸。服三月而精神健。肌肉充矣。
震按此条辨证甚佳。所谓是心病非肾病者。亦缘脉洪大不细数耳。
东宿云。金良美年十八。患咳嗽吐红。下午潮热。梦遗。市医进四物汤加二冬、知、柏
等。治半年。反加左胁胀疼。不时侧卧。声音渐哑。饮食辄恶心。肌肉大削。六脉俱数。医
告技穷。因就予治。观其面色白。又隐隐有清气夹之。两足痿弱无力。予曰。此证气虚血热
而肝脉甚弦。弦则木气太旺。脾土受亏。不能统血。始殆怒气所触。继为寒凉之剂所伤。
以致饮食恶心。肌肉瘦削。书云。脾胃一虚。肺气先绝。以肺金不足。则肝木愈无所制。浊
痰瘀血凝于肺窍。故咳嗽声哑。滞于肝叶。故左胁不能贴席而卧。病势危矣。喜在青年。犹
可措手。因急用人参二钱。鳖甲五钱。白术、白芍、陈皮、茯苓、通草、贝母各一钱。甘草
丹皮各七分。桔梗五分。计三十帖而咳嗽潮热俱减。声音清。左胁可卧。后以大造丸调理
全安矣。因嘱之曰。病愈虽可喜。而弦脉未退。切忌恼怒及劳心劳力之事。若劳怒相触。
血来必不能御也。此后精神日旺。肌体丰肥。六年无事。一日因结算劳心。加以大怒。则血
如泉涌。顷刻盈盆。上唇黑肿。汗出淋漓。急请予诊。脉乱无伦。渠语近侍欲大解。予曰。
此死征也。阴阳乖离矣。即辞出。未离门而气绝。
罗谦甫治疗建康道周卿的儿子。他二十三岁。在至元戊寅年春季。患发热、肌肉消瘦、四肢倦怠嗜睡、盗汗、大便稀溏次数多、肠鸣、不想吃东西、舌不知味、懒言少语的症状。病情时好时坏，持续了半年多。罗谦甫诊察他的脉象浮数，重按无力。这正应验《浮脉歌》所说的：“脏中积冷营中热。欲得生津要补虚。”先灸中脘穴，这是胃的募穴。使清阳之气上行，充实腠理。又灸气海穴，使元气生发，滋养百脉，长养肌肉。又灸足三里穴，这是胃的下合穴，也能助益胃气，撤除上部的热邪使其下行进入阴分。用甘寒的药剂泻火热，佐以甘温的药物养护其中气。又吃粳米、羊肉之类的食物，巩固胃气。告诫他要慎言语、节饮食、克制愤怒、节制欲望。病情日渐减轻，几个月后，气机平复。等到两年后，身体肥胖程度超过平时一倍。有人说：“世间的医生治疗虚劳病，多用苦寒的药剂。您用甘寒药，还让病人吃羊肉来助发热，大家都忌讳这个，而您反而让他吃，为什么呢？”罗谦甫说：“《内经》说：‘火位之主，其泻以甘。’《藏气法时论》说：‘心苦缓，急食酸以收之，以甘泻之。’泻热补气，非甘寒不可。如果用苦寒药泻脾土，会使脾土更加虚弱，火邪更加严重罢了。”又说：“形体不足的，用气来温养它；精不足的，用味道来补益它。劳累的病要用温法，亏损的病要用补益法。补法可以去弱。人参、羊肉之类就是例子。人参能补气虚，羊肉能补血虚。吃羊肉有什么可疑的呢？”
俞震按：罗公治疗总管史侯儿子的便血，以及运使崔君长子的心脾痛，都灸这三个穴位。所讲的灸穴的道理也是相同的。想他因此取得疗效的情况很多了。柳公度说：“我过去多病，常苦于气短。因为灸了气海穴，气就不急促了。从此每年必须灸一两次，因为气怯的缘故。”综合这两家的说法，那么虚损病用药难以见效，不如用灸法。《扁鹊新书》记载绍兴年间，有个步兵叫王超，本是太原人。后来在江湖上做盗贼。年纪到了九十岁，精神饱满，皮肤滋润。能每天与十个女子行房而不衰败。岳阳百姓家多受他害。后来被擒获。临刑时，监官问他说：“你有异术吗？真的吗？”他说：“没有。只有火力罢了。每到夏秋之交，就灼烧关元穴一千壮。久而久之不畏寒暑，多天不觉得饿。到现在脐下有一块地方，像火一样温暖。难道没听说过土变成砖，木头变成灰，千年不朽，都是火的力量吗？”死后，刑官命令剖开他腹部温暖的地方，得到一块非肉非骨的东西，凝固得像石头，这就是艾火的功效。所以说：“保命的方法，灼艾第一。”我私下思考，灼艾达到一千壮，只有能忍受别人不能忍受的痛苦的人，才能做别人不能做的事。这也非常难了。
朱丹溪治疗一个老人。七十九岁。头目昏眩且沉重，手足无力，吐痰连续不断。左脉散大而缓，右脉缓大不及左脉。重按都无力。饮食稍微减少而且微渴，大便四天一次才解。医生投用风药。朱丹溪说：“如果用风药，到春天必死。这是大虚证，应该大补。用人参、[此处原文缺字，通常为黄芪或类似补气药]、当归、白芍、白术、陈皮浓煎。送服连柏丸三十粒。服用一年后，精力如壮年。连柏丸用姜汁炒，姜汁糊丸。”
俞震按：脉缓大，重按无力，用人参、[缺字]、白术是对的。为什么用连柏丸呢？难道是因为他微渴、大便四天一行吗？或者是因为脉缓大为热吗？
又治疗一个人。体型肥大，面色苍黑浓重。因为厚味导致消渴症。投用寒凉药。病愈后，吃黄雌鸡滋补。大约吃到一千只。患上膈满呕吐。医生投用丁香、沉香、附子的药剂。一百帖而痊愈。正值大热天，仍然怕风，怕地气。于是堆糠铺席，遮蔽风口而居住。动止呼吸言语都不能。丹溪诊察他的脉象四至（脉搏跳动缓慢），浮大而虚。这是内有湿痰，因为多服燥热药导致气散血耗。正当夏令，本该死。幸亏他面色苍黑浓重，胃气还在。用人参、[缺字]、白术熬膏，煎淡五味子汤，加入竹沥调服。三天诸证全部消除。让他断绝肉食。一个多月平复。因为多吃鸡蛋，患上胸腹膨胀。自己用二陈汤加香附、白豆蔻。胀满顿时消除。于是让他断绝肉食，不用药自然安宁。
俞震按：动止呼吸言语都不能，其虚象还容易看清。热天畏风怕地气，脉又四至，人们必定仍视为寒证。丹溪判断为湿痰，是推究前因吃一千只鸡导致的膈满呕吐而悟出的。至于说是虚寒之象，因为多服燥热药导致气散血耗所致，见识高人百倍。用人参、[缺字]、白术煎膏，与脉浮大而虚恰好吻合。他的消痰药只用一味，妙极了。用淡五味子汤送服，五味子收敛散乱的气，淡则味薄，兼能濡养耗伤的血液。况且用于暑月更为适宜。究因选药，巧妙不可及。让他断绝肉食善后，尤其好。
吴球治疗一个贵宦。七十岁。年轻时患虚损。喜欢服用补剂。有一天事情不顺心，头目眩晕，精神短少。于是告诉医生平时多服人参，效果很快。于是竞相用人参熟地汤药，以及固本丸并进。反而加气急。吴球诊察他的脉大力薄。兼问病情，因而得知说：“先生归隐之意迫切，当权者苦苦挽留。抑郁而致病罢了。医生不审察同病异名、同脉异经的说法。气郁而一概用补药，所以病情日益加重。”宦官说：“这话深深击中我的病根。”最终用四七汤几剂，宽快而痊愈。
俞震按：这位老人原本就是虚证。后来加剧的，是由于郁结罢了。用补药而病情转增，自然应当寻找其他原因。只因为脉大力薄，仍属虚脉，所以要问而知之。
虞恒德治疗一个人。三十岁。三月间，房事后骑马渡河。遇到深渊沉没。幸好马健壮无事。穿着湿衣服走了十五里到家。第二天憎寒壮热，肢节烦疼。似疟非疟的样子。医生当作虚证治疗而补气血。一个月多无效。换医生当作痨瘵治疗。用四物汤加知母、黄柏、地骨皮之类。以及大补阴丸倍加紫河车。服用到九月，反而增加满闷不食。雇用的乳母每天喝乳汁四五杯，粒米不食。虞恒德诊视六脉皆洪缓，重按若牢。右手更甚。虞恒德当作湿郁治疗。用平胃散倍加苍术、白术、茯苓、半夏、川芎、香附、木通、砂仁、羌活、防风。加生姜煎服。黄昏一帖，一更时又一帖。到半夜，遍身发红丹如瘾疹。片刻消失而大汗。随即吃稀粥两碗。由此诸病皆减。能吃饭。仍给前方服三帖。后用茯苓渗湿汤倍加白术。服二十帖而安。
俞震按：溺水不换湿衣，又值远途，第二天就生病。怎么会遂以虚损治。大概庸医着眼在房事后罢了。拖延到半年，病势益重。而其脉仍不是虚损脉。所以以湿郁治即愈。结合上面两个案例一起看，可见病因也……（原文此处似乎有缺漏或中断，但根据上下文逻辑，意指需仔细辨证病因）。
汪石山治疗一个人。三十多岁。神色清减。起初因为伤寒过汗。此后两脚时常冷，身体常恶寒。能吃易饥。日渐消瘦。频频梦遗。筋骨疼痛。久卧枕榻。医生用滋阴降火无效。汪石山视左脉浮虚而缓，右脉浮弦而缓。于是说：“脚冷身寒，是阳虚的表现。又汗多亡阳。怎么能当作阴虚治。吃了就易饥的不是阴虚火动。盖脾胃以气为主，气属阳。脾胃之阳已虚，又用属于阴的苦寒药泻之，所以阳更虚而内空竭。必须借谷气来扶助它。所以易饥而想吃饭。虽然吃也不生肌肉。《内经》说：‘饮食自倍，肠胃乃伤。’又说：‘饮食不为肌肤。’说的就是这个意思。梦遗也不是特指阴虚。《内经》说：‘阳气者，精则养神，柔则养筋。’现在养气虚不能养神，则睡眠不安而神不藏于心。不能养筋，则筋骨疼痛而魂不藏于肝。神魂失所，怎能不遗泄呢？《内经》说：‘气固形实。’阳虚则不能固，而精门失守。这就是遗泄频繁不禁的原因。《内经》说：‘肾者胃之关也。’现在如果助阳使其固，养胃以守住其关，何必担心遗泄不止。”于是用人参、[缺字，通常为黄芪]各二钱，白术一钱，甘草五分，枳实、香附、山楂、韭子各五分。煎服半年。随时令寒暄升降，而改变其佐使药。于是完全安康。
俞震按：以上诸案，都与现今所谓的损怯不同。所以也没有用滋阴润肺药的。下一条则全像今之损怯。而用药却平正可法。
又一人三十多岁。体质弱而面色苍。起初觉得右耳有时冷气呵呵如箭出。过了两个多月，左耳气出如右。早晨声音哑。胸前有块攒聚发热。晨后声音哑稍开。攒聚发热暂息。一会儿攒聚发热又如此。有时咳嗽恶酸水。小便频赤。大便溏泄。即使睡熟，也被咳醒。呃逆恶二三声。胸腹作胀。头脑昏痛不堪。时而发热。浑身疼痛。天明前证稍息。惟攒聚发热不休。且近来午后背甚觉寒。两腿麻冷。用人参二钱五分。茯苓、麦冬、白术各一钱。黄连、甘草、枳实各五分。贝母、当归身各一钱。白芍八分。煎服。
江应宿治疗祁门人周三。近三十岁。潮热咳嗽咽哑。诊察他。六脉弦数。周某素以酒豪著称。早年醉后呕血数升。遂咳不止。百治不应。肌瘦食减。烦躁喘满。江应宿给四物汤换生地。加贝母、丹皮、麦冬、五味子、阿胶煎服。加蔗浆一小杯。姜汁少许。嗽渐止。食少。再加白术、茯苓、人参。食渐进。夜里含服太平丸。早晨服六味丸合生脉散。加枸杞为丸。两个月嗽止。半年肥白如初。
俞震按：此条纯是今人治损怯法。两个月嗽止。半年全愈。也有这种情况。但不能尽如是耳。
李士材治疗福建何金阳令郎。患虚损梦遗盗汗。羸顿已极。检查他所服的药。以四物汤、知母、黄柏为主。黄芩、黄连、天冬、麦冬为加减。诊察他的脉大而数。重按极软。李士材说：“中气大寒，反被药物之苦害了。”于是用归脾汤。入肉桂一钱。人参五钱。当晚得熟睡。居十日而汗止精藏。再以还少丹兼进。补中益气汤间服。一月而痊愈。
俞震按：脉大而数。重按极软。确实宜温补。然而用温补，得数脉退则愈。数脉不退则仍不愈。也只有大而数。重按极软。故可温补。若细而数。重按极软。死期已近。温补有何益呢？
又治疗刑部主政唐名必。劳心太过。因食海鲜吐血。有痰。喉间如鲠。日晡烦热。喜其六脉不数。惟左寸涩而细。右关大而软。思虑伤心脾也。用归脾汤大料。加丹皮、麦冬、生地。二十剂而证减六七。兼服六味丸三月。遂不复发。
吴门张饮光发热干咳。呼吸喘急。服苏子降气汤。不应。服八味丸。喘益急。迎李士材视之。两颊俱赤。六脉数大。说：“这是肺肝蕴热。”用逍遥散用牡丹皮一两。苡仁五钱。兰叶三钱。连进二剂而喘顿止。用地黄丸料用麦冬、五味子煎膏。及龟胶为丸。至十斤而康。
俞震按：上一条于左寸右关。得其病因。这一条以服温纳不应。悟其病因。上一条喜脉之不数。这一条喜脉之数大。盖二人俱系新病。一虚一实。尚易辨耳。
又说。南都许轮所孙女。吐血痰嗽。六月诊察她。两尺如烂绵。两寸大而数。我说金以火为仇。肺不浮涩。反得洪大。贼脉见矣。秋令可忧。八月初五复诊。肺之洪者变为细数。肾之软者变为疾劲。我说：“岁在戊午。少阴司天。两尺不应。今尺当不应而反大。寸当大而反沉细。尺寸反者死。肺至悬绝。十二日死。计其期。当死于十六日。然能食者过期。况十六十七二日。皆金未遽绝也。十八日交寒露。又值火日。《内经》说：‘手太阴气绝。丙日笃。丁日死。’言火日也。寅时乃气血注肺之时。不能注则绝。必死于十八日寅时矣。”轮所以其能食未深信也。至十八。果未晓而终。
俞震按：这真是入理深谈。粗心者哪得如是通盘打算。
侍御冯五玉令爱。发热咳嗽。已及半载。十月间。吐鲜血甚多。每日只食稀粥一盏。大肉消陷。大便溏泄。沉困着床。脉来七至。李士材说：“法在不救。人所共知。若能惟余是听。不为旁挠。可救十中之一。每帖用人参五钱。桂、附各一钱。[缺字]、术三钱。归、芍二钱。陈皮一钱。日投三帖。约进七十剂。及壮水丸三斤。而后起于床。又三月而饮食如旧矣。”
俞震按：昔贤治虚劳。每以参、术、桂、附奏奇功。遂诋丹溪滋阴药不可用。深斥苦寒之非。此亦矫枉过正。我亲眼见到吐血能进人参的。日服二三钱。甚相安。不旋踵而血仍吐。益加参亦复吐。不半年死。又见以参汤送八味丸的。初若效。后则咽痛热甚。不得不停矣。上一条乃是必死之证。而用参五钱。桂、附各一钱。日进三帖。殊难信。然能日进三帖。至七十剂。
孙东宿治疗张子。弱冠病瘵。其证咳嗽。下午热从两足心起。渐至头面。夜半乃退。面色青。形羸气促。交睫即梦遗。奄奄一息。孙东宿诊察他的脉。左寸短弱。右关略弦。余皆洪大。因而许诺可以治。病人说：“医生都说火起九泉者死。大肉尽削者死。咳嗽加汗者死。脉不为汗衰者死。何况当夏令。肺金将绝。先生独言可治。为什么呢？”孙东宿说：“证虽危。色声脉三者尚有生意。两颧不赤。心火未焚也。声音不哑。肺金未痿也。耳叶不焦。肾水未涸也。据面青者忧疑不决。左寸短者心神不足。关略弦者谋为不遂。必因志愿高而不称其心。谋为而不遂其欲。殆心病。非肾病也。《内经》说：‘色脉相得者生。’故许可治。”病人恍然说：“是的。我因为星士决断上科必售。我仍落第。而同窗者中举。故怏怏至此。如今也忘了病源了。”于是为他定方。以人参、枣仁、龙骨为君。丹参、石斛、贝母、麦冬、五味子为臣。山栀、香附为佐。二十帖而病起。丸方则人参、麦冬、五味、熟地、枸杞、龟板、茯苓。蜜丸。服三月而精神健。肌肉充矣。
俞震按：此条辨证甚佳。所谓是心病非肾病者。亦缘脉洪大不细数耳。
东宿说。金良美年十八。患咳嗽吐红。下午潮热。梦遗。市医进四物汤加二冬、知、柏等。治半年。反加左胁胀疼。不时侧卧。声音渐哑。饮食辄恶心。肌肉大削。六脉俱数。医告技穷。因就予治。观其面色白。又隐隐有清气夹之。两足痿弱无力。我说：“此证气虚血热而肝脉甚弦。弦则木气太旺。脾土受亏。不能统血。始殆怒气所触。继为寒凉之剂所伤。以致饮食恶心。肌肉瘦削。书云。脾胃一虚。肺气先绝。以肺金不足。则肝木愈无所制。浊痰瘀血凝于肺窍。故咳嗽声哑。滞于肝叶。故左胁不能贴席而卧。病势危矣。喜在青年。犹可措手。因急用人参二钱。鳖甲五钱。白术、白芍、陈皮、茯苓、通草、贝母各一钱。甘草、丹皮各七分。桔梗五分。计三十帖而咳嗽潮热俱减。声音清。左胁可卧。后以大造丸调理全安矣。因嘱之曰。病愈虽可喜。而弦脉未退。切忌恼怒及劳心劳力之事。若劳怒相触。血来必不能御也。此后精神日旺。肌体丰肥。六年无事。一日因结算劳心。加以大怒。则血如泉涌。顷刻盈盆。上唇黑肿。汗出淋漓。急请予诊。脉乱无伦。渠语近侍欲大解。我说：‘此死征也。阴阳乖离矣。’即辞出。未离门而气绝。”
Luo Qianfu treated the son of Zhou Qing, a Dao official in Jiankang. He was twenty-three years old. In the spring of the Wuyin year of the Zhiyuan era, he suffered from fever, muscle wasting, fatigue and heaviness in the four limbs, lethargy, night sweats, frequent loose stools, borborygmus, anorexia, loss of taste sensation on the tongue, and reluctance to speak. The condition came and went intermittently for over half a year. Luo palpated his pulse as floating and rapid, but forceless upon deep pressure. This corresponds precisely with the *Song of Floating Pulse*: "Cold accumulates in the zang organs, while heat resides in the Ying (Nutrient) level. To generate fluids and restore vitality, one must tonify deficiency." First, moxa was applied to Zhongwan (CV12), the Front-Mu point of the Stomach, to guide clear Yang qi upward and fatten the Couli (interstices). Moxa was then applied to Qihai (CV6) to stimulate the generation of Yuan (Original) qi, nourish the hundred vessels, and promote muscle growth. Finally, moxa was applied to Zusanli (ST36), the Lower-He Sea point of the Stomach, to assist Stomach qi and draw upper heat downward into the Yin level. A sweet-cold formula was used to drain fire-heat, assisted by sweet-warm herbs to nourish Middle Qi. The patient was also advised to consume foods such as japonica rice and mutton to consolidate Stomach qi. He was instructed to guard his speech, moderate his diet, restrain anger, and curb desires. His condition gradually improved, and within months his Qi returned to balance. Two years later, his body weight had doubled that of his previous state. Someone asked: "Physicians today typically treat Xu Lao (Deficiency Consumption) with bitter-cold formulas. You use sweet-cold herbs and even prescribe mutton, which is considered heating and usually avoided. Why?" Luo replied: "The *Neijing* states: 'For disorders of the Fire position, drainage should be achieved with sweet flavors.' The *Zangqi Fashi Lun* states: 'The Heart dislikes flaccidity; quickly use sour to astringe it, and sweet to drain it.' To drain heat and tonify Qi, sweet-cold is indispensable. If bitter-cold herbs are used to drain the Earth element, the Spleen Earth will become even more deficient, and the Fire pathogen will intensify further." He continued: "For those with insufficient form, warm them with Qi; for those with insufficient essence, tonify them with flavor. For exhaustion, apply warming methods; for damage, apply tonification. Tonification can counteract weakness. Ginseng and mutton are examples. Ginseng tonifies Qi deficiency; mutton tonifies Blood deficiency. What doubt is there in eating mutton?"
Yu Zhen noted: Master Luo applied moxibustion to these three points for the bleeding stool of the General Shi's son and for the Heart-Spleen pain of the Transport Commissioner Cui's eldest son. The rationale for these acupoints is consistent. It is likely that he achieved many successes through this method. Liu Gongdu said: "I used to suffer from frequent illness and shortness of breath. After moxibustion on Qihai (CV6), my breathing became unlabored. Since then, I have required moxibustion once or twice annually due to Qi deficiency." Combining these two accounts suggests that when herbal medicine fails for Xu Sun (Deficiency Damage), moxibustion is preferable. The *Bianque Xin Shu* records that during the Shaoxing era, a foot soldier named Wang Chao, originally from Taiyuan, became a bandit in the lakes and rivers. At ninety years old, he possessed vibrant spirit and supple skin. He could engage in sexual intercourse with ten women daily without decline, causing distress to families in Yueyang. Upon his capture and impending execution, the supervising official asked: "Do you possess extraordinary arts? Is this true?" He replied: "No. Only the power of fire. Every summer and autumn transition, I burned one thousand moxa cones on Guanyuan (CV4). Over time, I feared neither cold nor heat, and could go days without hunger. Even now, a patch below my navel remains warm as fire. Have you not heard that earth becomes brick and wood becomes ash, yet remains indestructible for millennia due to the power of fire?" After death, the executioner ordered an autopsy of the warm area of his abdomen, revealing a substance neither flesh nor bone, solid as stone. This demonstrates the efficacy of moxibustion. Thus it is said: "The primary method for preserving life is burning moxa." I ponder that burning one thousand cones requires enduring what others cannot bear, thereby achieving what others cannot do. This is indeed difficult.
Zhu Danxi treated an elderly man, seventy-nine years old. He presented with dizziness and heaviness of the head and eyes, weakness in the hands and feet, continuous expectoration of phlegm. The left pulse was scattered, large, and slow; the right pulse was slower and less large than the left. Deep pressure revealed forcelessness in both. Food intake was slightly reduced, accompanied by slight thirst. Bowel movements occurred only once every four days. The physician prescribed wind-dispelling herbs. Zhu Danxi stated: "If wind herbs are used, death is certain by spring. This is a severe deficiency syndrome requiring major tonification. Use a strong decoction of Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium). Administer thirty pills of Lianbai Wan (Coptidis and Phellodendri Pill) with it. After one year of treatment, his energy would resemble that of a young adult. Lianbai Wan should be stir-fried with ginger juice and formed into pills using ginger juice paste."
Yu Zhen noted: A slow, large pulse that is forceless upon deep pressure justifies the use of Renshen (Ginseng Radix et Rhizoma), [missing character], and Baizhu (Atractylodis Macrocephalae Rhizoma). Why use Lianbai Wan (Coptidis and Phellodendri Pill)? Was it because of his slight thirst and infrequent bowel movements? Or did the physician interpret the slow, large pulse as heat?
He also treated a man who was obese with a dark complexion. Due to rich dietary habits, he developed Xiao Ke (Wasting-Thirst). Cold-cooling herbs were administered. After recovery, he consumed approximately one thousand yellow hens for nourishment. He subsequently developed chest fullness and vomiting. Physicians prescribed formulas containing Dingxiang (Caryophylli Flos), Chenxiang (Aquilariae Lignum Resinatum), and Fuzi (Aconiti Lateralis Radix Praeparata). After one hundred doses, he recovered. However, during intense summer heat, he remained aversive to wind and damp ground. He piled chaff and mats to shield himself from wind, unable to move, breathe, or speak. Danxi palpated his pulse at four beats per cycle, floating, large, and empty. This indicated internal Damp-Phlegm caused by excessive consumption of drying-hot herbs, leading to dispersion of Qi and depletion of Blood. Although summer should have been fatal, his dark complexion indicated remaining Stomach Qi. A paste of Renshen (Ginseng Radix et Rhizoma), [missing character], and Baizhu (Atractylodis Macrocephalae Rhizoma) was boiled, mixed with Dan Wuweizi Tang (Light Schisandra Decoction) and Zhuli (Bambusae Caulis in Taenia), and taken orally. Within three days, all symptoms resolved. He was instructed to abstain from meat. After a month, he recovered. However, after consuming many eggs, he developed abdominal distension. He self-prescribed Erchen Tang (Two-Aged Decoction) plus Xiangfu (Cyperi Rhizoma) and Baidoukou (Amomi Fructus Rotundus). The distension vanished immediately. He was again instructed to abstain from meat and avoid medication for natural peace.
Yu Zhen noted: The inability to move, breathe, or speak clearly indicates severe deficiency. Fear of wind and ground dampness in summer, combined with a slow pulse, might lead one to suspect cold. Danxi’s diagnosis of Damp-Phlegm was derived from tracing the cause back to the consumption of a thousand chickens leading to chest fullness and vomiting. His insight that the deficiency-cold signs resulted from Qi dispersion and Blood depletion due to prior drying-hot herbs was superior by hundreds of times. The use of Renshen (Ginseng Radix et Rhizoma), [missing character], and Baizhu (Atractylodis Macrocephalae Rhizoma) paste matched the floating, large, and empty pulse perfectly. Using only one herb for resolving phlegm was exquisite. Sending it with light Wuweizi Tang allowed Wuweizi (Schisandrae Chinensis Fructus) to astringe dispersed Qi; its light flavor nourishes depleted Blood. Its use in summer was particularly appropriate. Investigating the cause and selecting herbs was ingenious. Advising meat abstinence for convalescence was excellent.
Wu Qiu treated a noble official, seventy years old. He had suffered from Xu Sun (Deficiency Damage) since youth and liked taking tonic preparations. One day, frustrated by events, he experienced dizziness and mental fatigue. He told the doctor that his usual consumption of Renshen (Ginseng Radix et Rhizoma) yielded rapid results. Consequently, doctors aggressively prescribed Renshen Shudi Tang (Ginseng and Rehmannia Decoction) and Guben Wan (Root-Firming Pill) simultaneously. This aggravated his shortness of breath. Wu palpated his pulse as forceful in superficial layers but weak upon pressure. Upon inquiry, he deduced: "You desire retirement, but authorities insist you stay. Your illness stems from depression. Physicians fail to distinguish between same-disease-different-names and same-pulse-different-channels. They blindly tonify Qi stagnation, worsening the condition." The official replied: "Your words hit the mark." He was cured after several doses of Siqi Tang (Four-Seven Decoction).
Yu Zhen noted: The elder originally had a deficiency syndrome. The aggravation was due to stagnation. Tonics worsened the condition, necessitating investigation of other causes. The pulse being forceful superficially but weak deeply still indicated deficiency, hence the need for inquiry.
Yu Hengde treated a man, thirty years old. In March, after sexual intercourse, he rode a horse across a river, fell into a deep abyss, and was submerged. The horse survived. He walked fifteen li home in wet clothes. The next day, he experienced aversion to cold, high fever, and painful joints, resembling malaria but not quite. Physicians treated him as deficiency, tonifying Qi and Blood for over a month with no effect. Another physician diagnosed it as Zhai (Consumption Tuberculosis), prescribing Siwu Tang (Four Substances Decoction) plus Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), Digupi (Lycii Cortex), and Dabu Yin Wan (Great Yin Pill) with extra Haichong (Placenta Humana). By September, he developed abdominal fullness and anorexia. A nurse fed him 4-5 cups of milk daily; he ate no grain. Yu palpated all six pulses as flooding and slow, firm upon deep pressure, especially on the right. Yu diagnosed Damp-Stagnation. He prescribed Pingwei San (Calm the Stomach Powder) with doubled Cangzhu (Atractylodis Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Banxia (Pinelliae Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xiangfu (Cyperi Rhizoma), Mutong (Akebiae Caulis), Sharen (Amomi Fructus), Qianghuo (Notopterygii Rhizoma et Radix), and Fangfeng (Saposhnikoviae Radix), added with fresh ginger. One dose at dusk, another at first watch. By midnight, his whole body broke out in red macules like urticaria, which disappeared shortly after followed by profuse sweating. He then ate two bowls of thin porridge. Symptoms subsided, appetite returned. He took three more doses of the same formula. Thereafter, Fuling Shen Shi Tang (Poria Damp-Draining Decoction) with doubled Baizhu (Atractylodis Macrocephalae Rhizoma) was given for twenty doses, resulting in stability.
Yu Zhen noted: Remaining in wet clothes after drowning, combined with a long journey, led to immediate illness. Why diagnose deficiency? Quack physicians focused solely on the post-coital timing. Delayed for half a year, the condition worsened, yet the pulse remained non-deficient. Hence, treating Damp-Stagnation succeeded. Comparing these cases highlights the importance of identifying the root cause.
Wang Shishan treated a man over thirty. His expression was pale and diminished. Initially, excessive sweating for Taiyang Shanghan (Cold Damage) led to cold feet and general aversion to cold. He had a good appetite and felt hungry easily but wasted away. He experienced frequent nocturnal emissions and bone-tendon pain, spending much time in bed. Doctors used Yin-nourishing and fire-draining methods without success. Wang observed the left pulse as floating, empty, and slow; the right pulse as floating, wiry, and slow. He stated: "Cold feet and body indicate Yang deficiency. Excessive sweating leads to Yang collapse. How can this be treated as Yin deficiency? Hunger after eating is not Yin deficiency with Fire hyperactivity. The Spleen and Stomach rely on Qi, which belongs to Yang. Spleen-Stomach Yang is already deficient; draining it with bitter-cold (Yin) herbs exacerbates Yang deficiency and empties the interior. Grain Qi is needed to support it. Hence the hunger. Even eating does not build muscle. The Classic says: 'Double the food intake, and the intestines and stomach are injured.' And: 'Food does not transform into flesh.' This applies here. Nocturnal emission is not solely Yin deficiency. The Classic says: 'Yang Qi nourishes the Spirit when refined, and tendons when soft.' Now, deficient Qi cannot nourish the Spirit, causing restless sleep and Spirit failing to reside in the Heart. It cannot nourish tendons, causing pain and Hun failing to reside in the Liver. With lost residence, how can emission cease? The Classic says: 'Qi secures the form.' Yang deficiency fails to secure, leading to leakage of Essence. This explains frequent emission. The Classic says: 'The Kidney is the gate of the Stomach.' Tonify Yang to secure it, nourish the Stomach to guard the gate. Why worry about stopping emission?" He prescribed Renshen (Ginseng Radix et Rhizoma) and [missing character, likely Huangqi] 2 qian each, Baizhu (Atractylodis Macrocephalae Rhizoma) 1 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 0.5 qian, Zhishi (Aurantii Fructus Immaturus), Xiangfu (Cyperi Rhizoma), Shanzha (Crataegi Fructus), and Jiu Zi (Allii Tuberosi Semen) 0.5 qian each. Decocted and taken for half a year, adjusting assistants and guides according to seasonal changes. Full recovery ensued.
Yu Zhen noted: These cases differ from modern "Sun Qie" (Consumption Decline). Thus, no Yin-nourishing Lung-moistening herbs were used. The next case resembles modern consumption, yet the prescription is sound and exemplary.
Another man, over thirty, frail with a dark complexion. Initially, he felt cold air whistling from the right ear like an arrow. Two months later, the left ear exhibited similar symptoms. Morning hoarseness, chest heat accumulation, improving slightly after morning, recurring later. Sometimes coughing up sour fluid, frequent red urine, loose stools. Sleep disturbed by coughing. Hiccups, abdominal distension, severe headache and dizziness. Intermittent fever and body ache. Symptoms eased before dawn, except for chest heat. Recently, back felt cold in afternoon, legs numb and cold. Prescription: Renshen (Ginseng Radix et Rhizoma) 2.5 qian, Fuling (Poria), Maidong (Ophiopogonis Tuber), Baizhu (Atractylodis Macrocephalae Rhizoma) 1 qian each, Huanglian (Coptidis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Zhishi (Aurantii Fructus Immaturus) 0.5 qian each, Beimu (Fritillariae Bulbus), Danggui (Angelicae Sinensis Radix) 1 qian each, Baishao (Paeoniae Radix Alba) 0.8 qian. Decocted and taken.
Jiang Yingsu treated Zhou San from Qimen, nearly thirty. He had tidal fever, cough, and hoarseness. All six pulses were wiry and rapid. Zhou was known as a heavy drinker. Years prior, he vomited blood after drunkenness, leading to persistent cough unresponsive to treatments. He wasted away, becoming irritable, asthmatic, and full. Jiang modified Siwu Tang (Four Substances Decoction) replacing Shudi with Shengdi (Rehmanniae Radix), adding Beimu (Fritillariae Bulbus), Danpi (Moutan Cortex), Maidong (Ophiopogonis Tuber), Wuweizi (Schisandrae Chinensis Fructus), and Ejiao (Asini Corii Colla). Decocted with a small cup of sugarcane juice and a little ginger juice. Cough gradually stopped. Appetite remained low. Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), and Renshen (Ginseng Radix et Rhizoma) were added. Appetite improved. He took Taiping Wan (Peaceful Empire Pill) at night and Liuhui Wan (Six-Wonder Pill) combined with Shengmai San (Generate the Pulse Powder) plus Gouqi (Lycii Fructus) as pills in the morning. Cough ceased in two months; body regained fatness and color in six months.
Yu Zhen noted: This case follows modern consumption treatment methods. Recovery in two months and full health in six months is possible, though not always so.
Li Shicai treated the son of Magistrate He Jinyang of Fujian. He suffered from Xu Sun (Deficiency Damage), nocturnal emissions, and night sweats, reaching extreme emaciation. His previous medications centered on Siwu Tang (Four Substances Decoction), Zhimu (Anemarrhenae Rhizoma), Huangbai (Phellodendri Cortex), with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Donggu (Donggu Tianmae Rhizoma), and Dongmi (Dongmi Ophiopogonis Tuber) as modifications. His pulse was large and rapid but extremely soft upon pressure. Li stated: "Middle Qi is severely cold, harmed by the bitterness of previous drugs." He prescribed GuiPi Tang (Restore the Spleen Decoction) with Rougui (Cinnamomi Cortex) 1 qian and Renshen (Ginseng Radix et Rhizoma) 5 qian. He slept well that night. Ten days later, sweating stopped and essence was retained. Huanshao Dan (Return to Youth Pill) was alternated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). He recovered in one month.
Yu Zhen noted: Large and rapid pulse, extremely soft upon pressure, indeed warrants warming tonification. However, if the rapid pulse does not subside with warming tonification, cure is unlikely. Only when large/rapid but soft can warming tonification work. If fine/rapid and soft, death is near; warming tonification is useless.
He also treated Tang Mingbi, Vice Minister of Justice. Overthinking led to hemoptysis after eating seafood, with phlegm and a foreign body sensation in the throat. Evening irritability. Favorably, the six pulses were not rapid; only the left Cun was choppy and fine, and the right Guan was large and soft. This indicated Heart-Spleen damage from worry. A large dose of GuiPi Tang (Restore the Spleen Decoction) plus Danpi (Moutan Cortex), Maidong (Ophiopogonis Tuber), and Shengdi (Rehmanniae Radix) was given for twenty doses, reducing symptoms by 60-70%. Combined with Liuhui Wan (Six-Wonder Pill) for three months, recurrence ceased.
Zhang Yinguang from Wu men suffered fever, dry cough, and rapid breathing. Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) failed. Bawei Wan (Eight-Treasure Pill) worsened asthma. Li Shicai examined him: both cheeks were red, six pulses rapid and large. "This is Heat hidden in Lung and Liver." Xiaoyao San (Free and Easy Wanderer Powder) was used with 1 liang of Mudanpi (Moutan Cortex), 5 qian of Yiyiren (Coicis Semen), and 3 qian of Lanye (Magnoliae Folium). Two doses stopped asthma abruptly. Dihuang Wan material was decocted with Maidong (Ophiopogonis Tuber) and Wuweizi (Schisandrae Chinensis Fructus) into a paste, combined with Guijiao (Testudinis Carapax et Plastrum) into pills. Consuming ten jin led to recovery.
Yu Zhen noted: The previous case identified the cause via Left Cun and Right Guan. This case inferred the cause from failure of warming retention. Previous case favored non-rapid pulse; this case favored rapid/large pulse. Both were new diseases, one deficiency, one excess, relatively easy to distinguish.
He also mentioned: The granddaughter of Xu Lunsuo from Nan Du suffered hemoptysis and phlegm-cough. In June, her Chi pulses felt like rotten cotton, while Cun pulses were large and rapid. I said: Metal fears Fire. Lung pulse should be floating/choppy, but is flooding/large—a thief pulse. Autumn brings worry. Re-examined on August 5th: Lung pulse changed from flooding to fine/rapid; Kidney pulse changed from soft to rapid/firm. I said: "In Wuwu year, Shaoyin governs Heaven. Chi pulses should be absent. Now Chi is large instead of absent; Cun should be large but is sunken/fine. Reversal of Cun-Chi indicates death. Lung pulse hanging absolute predicts death in twelve days. Calculating, he should die on the 16th. However, ability to eat may extend life. Days 16-17 show Metal not yet exhausted. Day 18 marks Cold Dew solar term, coinciding with Fire day. Classic says: 'Hand-Taiyin Qi exhaustion, severe on Bing day, death on Ding day' (Fire day). Yin hour is when Qi/Blood flows to Lung. Failure to flow means exhaustion. Death expected on Day 18, Yin hour." Xu doubted this due to his ability to eat. On the 18th, he died before dawn.
Yu Zhen noted: This is profound theoretical discussion. Careless minds cannot calculate so comprehensively.
The daughter of Censor Feng Wuyu suffered fever and cough for half a year. In October, she vomited large amounts of bright red blood. She ate only one bowl of thin porridge daily. Muscles wasted, bowels loose, bedridden. Pulse rate seven beats per cycle. Li Shicai said: "Medically incurable, as everyone knows. If you listen only to me and ignore others, one in ten chances of survival. Each dose: Renshen (Ginseng Radix et Rhizoma) 5 qian, Guifu (Cinnamomi Cortex and Aconiti Lateralis Radix Praeparata) 1 qian each, [missing character], Baizhu (Atractylodis Macrocephalae Rhizoma) 3 qian, Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba) 2 qian, Chenpi (Citri Reticulatae Pericarpium) 1 qian. Three doses daily. Approximately seventy doses, plus three jin of Zhuangshui Wan (Strengthen Water Pill), enabled him to rise. Three months later, diet normalized."
Yu Zhen noted: Ancients often achieved miracles with Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Praeparata) for Xu Lao (Deficiency Consumption), leading them to denounce Danxi’s Yin-nourishing drugs and bitterly criticize bitter-cold herbs. This is overcorrection. I personally saw hemoptysis patients taking 2-3 qian of Renshen daily with peace, only to bleed again shortly after increasing the dose, dying within half a year. I also saw patients taking Bawei Wan (Eight-Treasure Pill) with Ginseng soup; initially effective, later causing sore throat and intense heat, forcing cessation. The above case was surely fatal, yet using 5 qian Renshen and 1 qian Guifu three times daily is hard to believe. Yet, taking three doses daily for seventy doses...
Sun Dongsu treated Zhang Zi, a young man suffering from Zhai (Consumption). Symptoms included cough, afternoon fever starting from soles ascending to head, resolving at midnight. Complexion green, emaciated, shortness of breath, nocturnal emission upon falling asleep, barely alive. Sun palpated: Left Cun short/weak, Right Guan slightly wiry, others flooding/large. He promised treatment. Patient asked: "Doctors say Fire rising from Nine Springs is death, muscle wasting is death, cough with sweat is death, pulse not slowing with sweat is death. Especially in summer, Lung Metal is near extinction. Why do you say curable?" Sun replied: "Though critical, Color, Sound, and Pulse show signs of life. Cheeks not red: Heart Fire not burning. Voice not hoarse: Lung Metal not withered. Earlobes not scorched: Kidney Water not dried. Green face indicates worry/indecision. Short Left Cun indicates Heart Spirit insufficiency. Slightly wiry Right Guan indicates unfulfilled plans. Likely Heart disease, not Kidney, due to high aspirations unmet. Classic says: 'When Color and Pulse match, life prevails.' Hence, I promise treatment." Patient realized: "Yes. I was depressed because an astrologer predicted success in exams, but I failed while classmates succeeded. I forgot the source of illness." Formula: Renshen (Ginseng Radix et Rhizoma), Zaoren (Ziziphi Spinosae Semen), Longgu (Fossilia Ossis Mastodi) as Sovereign; Danshen (Salviae Miltiorrhizae Radix), Shihu (Dendrobii Caulis), Beimu (Fritillariae Bulbus), Maidong (Ophiopogonis Tuber), Wuweizi (Schisandrae Chinensis Fructus) as Ministers; Shanzhi (Gardeniae Fructus), Xiangfu (Cyperi Rhizoma) as Assistants. Twenty doses improved condition. Pill formula: Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Tuber), Wuweizi (Schisandrae Chinensis Fructus), Shudi (Rehmanniae Radix Preparata), Gouqi (Lycii Fructus), Guiban (Testudinis Carapax et Plastrum), Fuling (Poria) honey-pills. Taken for three months, spirit strengthened, muscles filled.
Yu Zhen noted: Excellent differentiation. "Heart disease, not Kidney" is justified by flooding/large pulse rather than fine/rapid.
Dongsu said: Jin Liangmei, eighteen, suffered cough, hemoptysis, afternoon tidal fever, nocturnal emissions. City doctors gave Siwu Tang (Four Substances Decoction) plus Donggu, Dongmi, Zhimu, Huangbai. After half a year, left hypochondriac distension/pain, side-sleeping preference, hoarseness, nausea, muscle wasting, and rapid six pulses developed. Doctors gave up. Seeking my treatment: Pale face with faint clear Qi, weak legs. I said: "Qi deficiency with Blood heat, Liver pulse very wiry. Wiry means Wood too strong, Spleen Earth deficient, failing to control Blood. Initially triggered by anger, then damaged by cold-cooling herbs. Nausea and wasting result. Classic says: 'When Spleen-Stomach is deficient, Lung Qi exhausts first.' Insufficient Lung Metal fails to control Liver Wood. Turbid Phlegm and Stasis congeal in Lung orifices (causing cough/hoarseness) and Liver lobes (causing inability to lie on left side). Critical condition. Fortunately young, still treatable." Urgent prescription: Renshen (Ginseng Radix et Rhizoma) 2 qian, Biejia (Trionycis Carapax) 5 qian, Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Tongcao (Akebiae Caulis), Beimu (Fritillariae Bulbus) 1 qian each, Gancao (Glycyrrhizae Radix et Rhizoma), Danpi (Moutan Cortex) 0.7 qian, Jiegeng (Platycodonis Radix) 0.5 qian. Thirty doses reduced cough/tidal fever, cleared voice, allowed lying on left side. Later, Dazao Wan (Great Creation Pill) restored health. Advice: Avoid anger and mental/physical labor while wiry pulse persists. Otherwise, hemorrhage will be uncontrollable. He recovered fully for six years. One day, stressed and angry, blood gushed like a spring, filling a basin. Upper lip black/swollen, profuse sweating. Emergency consultation: Pulse chaotic. He requested defecation. I said: "Sign of death. Yin-Yang separation." I left. He died before leaving the door.