姑苏朱子明妇。病长号数十声。暂止。复如前。人以为疠所凭。莫能疗。戴原礼曰。此
郁病也。痰闭于上。火郁于下。故长号则气少舒。经云。火郁则发之。是已。遂用重剂涌之
吐痰如胶者无算。乃愈。
易思兰治一妇。浑身倦怠。呵欠口干。经月不食。强之。不过数粒而已。有以血虚治之
者。有以气弱治之者。有知为火而不知火之源者。用药杂乱。愈治愈病。至冬微瘥。次年夏
间。诸病复作。肌消骨露。三焦脉洪大侵上。脾肺二脉微沉。余部皆平和。此肺火病也。以
栀子仁姜汁浸一宿。炒黑研细。用人参、麦冬、乌梅煎汤调下。进二服。即知饥喜食。旬日
肢体充实如常。后因久病不孕。众皆以为血虚而用参 之品。半月胸膈饱胀。饮食顿减。至
三月余而经始通。下黑秽不堪。或行或止。不得通利。其苦万状。复以四乌汤。换生地。加
陈皮、苏梗、黄芩、山栀、青皮、枳壳十数剂。一月内即有孕。
震按首条之病郁易辨。涌法诚胜于服药。次条之病情难辨。其方恐未能速效。至于经闭
已通。病亦轻矣。用药固宜平稳。
周慎斋治一人。六脉涩滞。胁痛吐臭痰。恶心食不下。盖胁者。少阳之分也。清气不升
浊气郁于少阳之络。故痛。浊气上逆。故吐臭痰而恶心。浊气。故臭也。食不下者。少阳
清阳之气不升。则肝不能散精也。用柴胡、白蔻各二分。黑山栀、甘草各五分。白芍、丹皮
各一钱。白茯苓、广皮各一钱五分。归身八分。麦冬二钱。十帖全愈。
震按胁痛吐臭痰。昧者必妄认肺痈肺痿等病。得此论可与石山治臭痰一案并垂不朽。
纪华山雅自负而数奇。更无子。时悒悒不快。渐至痞胀。四年肌肉尽削。自分死矣。姑
苏张涟水诊而戏之曰。公那须药。一第盒饭霍然。以当归六钱。韭菜子一两。香附童便炒八
钱。下之。纪有难色。不得已。减其半。张曰。作二剂耶。一服。夜梦遗。举家恸哭。张拍
案曰。吾正欲其通耳。仍以前半剂进。胸膈间若勇士猛力一推。解黑粪无算。寻啜粥二碗。
再明日。巾栉起见客矣。逾年生一子。
震按痞胀四年。肌肉尽削。一梦遗而半剂之药如神。虽仲淳所述。吾不敢信。
苏州朱子明的妻子。患病后长时间大声呼叫，持续数十声，暂时停止后，又重复之前的症状。人们认为是厉鬼附身，无法治疗。戴原礼说：“这是郁病。痰浊闭阻于上焦，火邪郁结于下焦，所以大声呼叫时气机稍微舒展。《内经》说：‘火郁则发之’，正是此理。”于是使用重剂催吐，吐出如胶状般的痰液无数，病才痊愈。
易思兰治疗一位妇女。浑身倦怠，打哈欠，口干，一个月不进食，强行喂食也不过吃几粒而已。有人用补血法治疗，有人用补气法治疗，有人知道是火邪却不知火的根源，用药杂乱无章，越治病情越重。到了冬天症状稍减，次年夏天，各种病症复发，肌肉消瘦，骨骼显露，三焦脉洪大且向上冲逆，脾肺二脉微沉，其他部位脉搏平和。这是肺火病。用栀子仁经姜汁浸泡一夜，炒黑研细，用人参、麦冬、乌梅煎汤调服。服用两剂后，即感到饥饿并喜欢进食，十天后肢体充实如常。后来因久病不孕，众人都认为是血虚而使用人参等补品。半个月后胸膈饱胀，饮食突然减少，过了三个多月月经才来潮，排出黑色污秽不堪的血液，或行或止，不通畅，痛苦万分。又用四物汤（此处原文为“四乌汤”，结合语境及常用方义，通常指四物汤加减，但依原文忠实翻译为四乌汤/四物汤之意，此处按原文字面译为四乌汤，注：古籍中“四乌”常通“四物”或特指某方，鉴于后文加味，暂译作四物汤类方剂或保留原名），替换生地黄，加入陈皮、苏梗、黄芩、山栀、青皮、枳壳，服用十余剂，一个月内即怀孕。
俞震按语：第一条的病证属于郁证，容易辨别，涌吐法确实胜过服药。第二条的病情难以辨别，那个方子恐怕不能迅速见效。至于月经已经通畅，病也轻了，用药固然应该平稳。
周慎斋治疗一个人。六脉涩滞，胁痛，吐出臭痰，恶心，无法进食。大概胁部是少阳经所主的部位。清气不升，浊气郁结在少阳的络脉，所以疼痛。浊气上逆，所以吐出臭痰并恶心。因为浊气，所以气味臭。无法进食，是因为少阳清阳之气不升，导致肝不能散精。使用柴胡、白蔻各二分，黑山栀、甘草各五分，白芍、丹皮各一钱，白茯苓、广皮各一钱五分，当归身八分，麦冬二钱，服用十帖完全痊愈。
俞震按语：胁痛吐臭痰，庸俗的医生必定会胡乱认定为肺痈、肺痿等疾病。得到这样的论述，可以与石山治疗臭痰的案例一起流传不朽。
纪华山自负才华但命运坎坷，又没有儿子。时常忧郁不快，逐渐发展为痞满胀气，四年间肌肉全部消瘦，自己认为必死无疑。苏州张涟水诊察后开玩笑说：“您哪里需要吃药？一盒饭的时间就会霍然痊愈。”于是用当归六钱，韭菜子一两，香附用童便炒制八钱，让他服下。纪华山面露难色，不得已减半剂量。张涟水问：“做成两剂吗？”结果一服下去，夜里梦遗，全家痛哭。张涟水拍案说：“我正是想要他通泄罢了。”仍然将剩下的一半药量给他服下。感觉胸膈间像勇士猛力一推一样，解出无数黑色粪便。随即喝了两碗粥。第二天，穿戴整齐出来见客了。过了一年生了一个儿子。
The wife of Zhu Ziming from Suzhou suffered from a condition where she would cry out loudly for dozens of times, pause briefly, and then resume. People believed she was possessed by malevolent spirits and could not be treated. Dai Yuanli said, "This is a case of Qi Depression (Yu Bing). Phlegm turbidity blocks the Upper Jiao, while Fire pathogen is depressed in the Lower Jiao; thus, crying out allows the Qi mechanism to relax slightly. The *Classic* states: 'When Fire is depressed, it must be dispersed.' This applies here." He subsequently used a heavy emetic agent, causing the patient to vomit an immeasurable amount of phlegm resembling glue, after which she recovered.
Yi Silan treated a woman who presented with general fatigue, yawning, dry mouth, and an inability to eat for a month; when forced, she consumed only a few grains. Some practitioners treated her for Blood Deficiency, others for Qi Weakness, and some recognized the presence of Fire but failed to identify its source. The medications were chaotic, and the more she was treated, the worse her condition became. By winter, symptoms subsided slightly, but in the following summer, all ailments recurred. Her muscles wasted away, bones became prominent, the pulse at the Sanjiao (Triple Burner) position was surging and large moving upward, while the Spleen and Lung positions were faint and deep; other positions were peaceful. This was diagnosed as Lung Fire disease. He used Gardenia seeds (Zhi Zi Ren) soaked in ginger juice overnight, stir-fried until black, and ground into fine powder, administered with a decoction of Ginseng (Ren Shen), Ophiopogon (Mai Dong), and Mume fruit (Wu Mei). After two doses, she felt hunger and desired food; within ten days, her limbs regained their normal fullness. Later, due to infertility caused by prolonged illness, everyone assumed it was Blood Deficiency and prescribed Ginseng and similar tonics. Half a month later, she experienced chest and diaphragmatic fullness and distension, and her appetite suddenly decreased. It took over three months for her menstruation to start, discharging foul, black impurities, intermittently flowing but obstructed, causing immense suffering. She was then treated with Siwu Tang (Four Substances Decoction) [Note: Text says Si Wu Tang, likely referring to Four Substances], substituting Rehmannia root (Sheng Di Huang), and adding Tangerine peel (Chen Pi), Perilla stem (Su Geng), Scutellaria (Huang Qin), Gardenia (Shan Zhi), Bitter orange rind (Qing Pi), and Aurantium fruit (Zhi Qiao). After more than ten doses, she conceived within a month.
Commentary by Zhen: The first case involves Depression syndrome, which is easy to differentiate; the emetic method is indeed superior to oral medication. The second case's pathology is difficult to discern, and that prescription may not have produced rapid effects. Once menstruation had resumed and the illness lightened, the medication should naturally be mild and stable.
Zhou Shenzhai treated a man whose six pulses were choppy and stagnant, accompanied by hypochondriac pain, vomiting of foul-smelling phlegm, nausea, and inability to eat. The hypochondrium is the domain of the Shaoyang (Lesser Yang) channel. When Clear Qi fails to ascend, Turbid Qi stagnates in the Shaoyang collaterals, causing pain. Turbid Qi counterflows upward, causing the vomiting of foul phlegm and nausea. Because it is Turbid Qi, it smells foul. The inability to eat occurs because the Clear Yang Qi of Shaoyang does not ascend, preventing the Liver from distributing essence. He used Bupleurum (Chai Hu) and White Cardamom (Bai Kou) each 2 fen, Black Gardenia (Hei Shan Zhi) and Licorice (Gan Cao) each 5 fen, White Peony Root (Bai Shao) and Moutan Bark (Dan Pi) each 1 qian, Poria (Bai Fu Ling) and Tangerine Peel (Guang Pi) each 1.5 qian, Angelica sinensis root body (Gui Shen) 8 fen, and Ophiopogon (Mai Dong) 2 qian. After ten prescriptions, he was completely cured.
Commentary by Zhen: Hypochondriac pain with vomiting of foul phlegm—vulgar physicians would certainly misdiagnose this as Lung Abscess (Fei Yong) or Lung Withering (Fei Wei). With such analysis, this case can stand immortal alongside Shi Shan's case of treating foul phlegm.
Ji Huashan was arrogant yet unlucky, having no sons. He was often depressed and unhappy, gradually developing abdominal fullness and distension. Over four years, his muscles wasted away completely, and he resigned himself to death. Zhang Lianshui from Suzhou examined him and jokingly said, "Why do you need medicine? You will recover instantly after one box of rice." He prescribed Dang Gui (Angelica sinensis) 6 qian, Leek seeds (Jiu Cai Zi) 1 liang, and Cyperus rhizome (Xiang Fu) stir-fried with child urine 8 qian, instructing him to take it. Ji showed reluctance and, under pressure, halved the dose. Zhang asked, "Should I make two doses?" Upon taking the first dose, Ji had a nocturnal emission, and the whole family wept bitterly. Zhang slapped the table and said, "I intended for him to unblock and discharge." He then administered the remaining half-dose. Ji felt as if a warrior had pushed forcefully within his chest and diaphragm, passing an immeasurable amount of black stool. He then drank two bowls of porridge. The next day, he dressed and received guests. A year later, he fathered a son.
Commentary by Zhen: Abdominal fullness and distension for four years, with complete muscle wasting, yet recovering miraculously after one nocturnal emission and half a dose of medicine. Although described by Zhongchun, I dare not believe it.