车驾王用之，卒中昏愦，口眼 斜，痰气上涌，咽喉有声，六脉沉伏。此真气虚而风邪所乘，以三生饮一
两，加人参一两，煎服即苏。若遗尿、手撒、口开、鼾睡，为不治，用
前药亦有得生者。夫前饮乃行经络治寒痰之药，有斩关夺门之功，每服必用人参两许，驾驭其邪而补助真气，
否则不惟无益，适足以取败矣。观先哲用 附、参附等汤，其义自见。
州判蒋大用，形体魁伟，中满吐痰，劳则头晕，所服皆
清痰理气。余曰∶中满者，脾气亏损也。痰盛者，脾气不能运也。头晕者，脾气不能升也。指麻者，脾气不
能周也。遂以补中益气加茯苓、半夏以补脾土，用八味丸以补脾母而愈。
一男卒中 斜，不能言语，遇风寒四肢拘急，脉浮而紧。此手足阳明经虚，风寒所乘。用秦艽升麻治之稍
愈，乃以补中益气加山栀而痊。若舌喑不能言，足痿不能行，属肾气虚弱，名曰痱症，宜用地黄饮子治之。
一男子，体肥善饮，舌本强硬，语言不清，口眼 斜，痰气涌盛，肢体不遂，
余以为脾虚湿热，用六君加煨葛根、山栀、神曲而痊。
佥宪高如斋自大同回，谓余曰∶吾成风病矣，两腿逸则痿软而无力，劳则作痛如针刺，脉洪数而有力。余
曰∶此肝肾阴虚火盛而致，痿软无力，真病之形，作痛如锥，邪火之象也。用壮水益肾之剂而愈。
大尹刘孟春，素有痰，两臂作麻，两目流泪，服祛风化痰药，痰愈盛，臂反痛不能伸手，指俱挛。余曰∶
麻属气虚，因前药而复伤肝，火盛而筋挛耳。况风自火出，当补脾肺、滋肾水，则风自息，火自退、痰自清。
遂用六味地黄丸、补中益气汤，不三月而愈。
进士王汝和，因劳役失于调养，忽然昏愦。此元气虚，火妄动，挟痰而作，急令灌童便，神思渐爽。更用
参、 五钱，芎、归各三钱，元参、柴胡、山栀、炙草各一钱，服之稍定。察其形倦甚，又以十全大补汤加五
味、麦冬，治之而安。此人元气素弱，或因起居失宜，或因饮食劳倦，或因用心太过，致遗精白浊，自汗盗汗
∶或内热、晡热、潮热发热；或口干作渴， 喉痛舌裂；或胸乳膨胀，胁肋作痛；或头颈时痛，眩晕目花；或
心神不宁，寤而不寐；或小便赤涩，茎中作痛；或
便溺余沥，脐腹阴冷；或形容不充，肢体畏寒；或鼻息急促；或更有一切热证，皆是无根虚火。但服前汤固
其根本，诸证自息。若攻其风热，则误矣。
光禄高署丞，脾胃素虚，因饮食劳倦，腹痛胸痞，误用大黄等药下之，谵语烦躁，头痛喘汗，吐泻频频，
时或昏愦，脉大而无伦次，用六君加炮姜，四剂而安。但倦怠少食，口干发热，六脉浮数，欲用泻火之药。余
曰∶不时发热，是无火也；脉浮大，是血虚也；脉浮虚，是气虚也。此因胃虚，五脏亏损，虚证发见。服补脾
胃之剂，诸证悉退。
大尹徐克明，因饮食失宜，日晡发热，口干体倦，小便赤涩，两腿酸痛，余用补中益气汤治之。彼知医，自
用四物、黄柏、知母之剂，反头眩目赤，耳鸣唇燥，寒热痰涌，大便热痛，小便赤涩；又用四物、芩，连、枳
实之类，胸膈痞满，饮食少思，汗出如水；再用二陈、芩连、黄柏、知母、麦冬、五味，言语谵妄，两手举拂。
屡治反甚。复求余，用参、 各五钱，归、术各三钱，远志、茯神、枣仁、炙草各一钱，服之熟睡良久，四剂
稍安，又用八珍汤调理而愈。夫阴虚乃肺虚也，脾为至阴，因脾虚而致前证。盖脾禀于胃，故用甘温之剂，以
生发胃中元气而除大热，胡乃反用苦寒，复伤脾血耶？若前证果属肾经阴虚，惟因肾经阳虚不能生阴耳，尤不
宜用苦寒之药，当用补中益气、六味地黄以补其母。此以脾虚误为肾虚，辄用黄柏、知母之类，反伤胃中生
气，害人多矣。大凡足三阴虚，多因饮食劳役，以致肾不能生肝，肝不能生火，而害脾土，不能滋化。但补脾
土，则金旺水生，木得平而自相生矣。
一儒者，素勤苦，因饮食失节，大便下血，或赤或黯，半载之后，非便血则盗汗，非恶寒则发热，血
汗二药用之无效，
六脉浮大，心脾则涩。此思伤心脾，不能摄血归源。然血即汗，汗即血，其色赤黯，便血盗汗，皆火之升降
微甚耳；恶寒发热，气血俱虚也。乃午前用补中益气，以补脾肺之原，举下陷之气；午后用归脾加麦冬、五
味，以补心脾之血，收耗散之液。不两月而诸证悉愈。
马生者，发热烦渴时或头痛，昨用发散药，反加喘急腹痛，其汗如水，昼夜谵语。余意此劳伤元气，误汗
所致，其腹心喜手按，询之果然，遂与十全大补汤加附子一钱，服之熟睡，唤之不醒，及觉诸证悉退。再剂
而痊。凡人饮食劳倦，起居失宜，见一切火症，悉属内真寒而外假热，故肚腹喜暖，口畏冷物。此乃形气病气
俱不足，法当纯补上元气为善。
清代官员王用之，突然中风昏迷，口眼歪斜，痰气上涌，咽喉有痰鸣声，六脉沉伏。这是真气虚弱而风邪乘虚而入，用三生饮一两，加入人参一两，煎服后立即苏醒。如果出现遗尿、手撒（手掌张开）、口开、鼾睡，属于不治之症，但使用前面的药物也有存活者。那三生饮是通行经络治疗寒痰的药物，有斩关夺门般的功效，每次服用必须用人参约一两，以驾驭邪气并补助真气，否则不仅无益，反而会导致失败。观察先哲使用附子、参附等汤剂，其中的道理自然显现。
州判官蒋大用，身体魁梧，中焦胀满且吐痰，劳累时头晕，所服用的都是清化痰热、理气的药物。我说：中焦胀满，是脾气亏损所致。痰多，是脾气不能运化所致。头晕，是脾气不能升举所致。手指麻木，是脾气不能周流全身所致。于是用补中益气汤加入茯苓、半夏来补益脾土，用八味丸来补益脾之母（肾）而痊愈。
一名男子突然中风口眼歪斜，不能言语，遇风寒则四肢拘急，脉象浮而紧。这是手足阳明经虚弱，风寒乘虚而入。用秦艽、升麻治疗稍有好转，后用补中益气汤加入山栀而痊愈。如果舌喑不能言，足痿不能行，属于肾气虚弱，名叫痱症，适宜用地黄饮子治疗。
一名男子，体型肥胖且喜好饮酒，舌根强硬，语言不清，口眼歪斜，痰气涌盛，肢体瘫痪，我认为这是脾虚湿热，用六君子汤加入煨葛根、山栀、神曲而痊愈。
佥宪高如斋从大同回来，对我说：我得了风病，两腿休息时痿软无力，劳累时疼痛如针刺，脉象洪数而有力。我说：这是肝肾阴虚火旺所致，痿软无力是真病的表现，疼痛如锥刺，是邪火的征象。用壮水益肾的药剂而痊愈。
大尹刘孟春，素有痰疾，两臂发麻，两目流泪，服用祛风化痰药后，痰更多，手臂反而疼痛不能伸展，手指全部挛缩。我说：麻木属于气虚，因为之前的药物又损伤了肝，导致火旺筋挛。况且风自火出，应当补脾肺、滋肾水，则风自息，火自退，痰自清。于是用六味地黄丸、补中益气汤，不到三个月而痊愈。
进士王汝和，因劳役失于调养，突然昏迷。这是元气虚弱，虚火妄动，挟带痰浊发作，急忙让人灌服童便，神志逐渐清爽。再用参、术各五钱，川芎、当归各三钱，元参、柴胡、山栀、炙甘草各一钱，服用后稍见安定。观察他形体非常疲倦，又用十全大补汤加入五味子、麦冬，治疗而平安。这个人元气素来虚弱，可能是因为起居不当，或因饮食劳倦，或因用心过度，导致遗精白浊，自汗盗汗；或内热、傍晚发热、潮热发热；或口干作渴，咽喉痛舌裂；或胸乳膨胀，胁肋作痛；或头颈时常疼痛，眩晕眼花；或心神不宁，醒着却睡不着；或小便赤涩，尿道疼痛；或大小便余沥不尽，脐腹阴冷；或形体消瘦，肢体畏寒；或鼻息急促；或有其他一切热证，这都是无根的虚火。只要服用前面的汤剂巩固根本，各种症状自然会平息。如果攻伐其风热，那就错了。
光禄寺署丞高某，脾胃素来虚弱，因饮食劳倦，腹痛胸痞，误用大黄等药泻下，出现谵语烦躁，头痛喘汗，吐泻频繁，时而昏迷，脉象大而无序，用六君子汤加入炮姜，四剂后安定。但倦怠少食，口干发热，六脉浮数，想用泻火的药。我说：不时发热，是无火（虚火）；脉浮大，是血虚；脉浮虚，是气虚。这是因为胃虚，五脏亏损，虚证显现。服用补脾胃的药剂，各种症状全部消退。
大尹徐克明，因饮食失宜，傍晚发热，口干体倦，小便赤涩，两腿酸痛，我用补中益气汤治疗。他懂医，自行服用四物汤、黄柏、知母的药剂，反而头眩目赤，耳鸣唇燥，寒热痰涌，大便热痛，小便赤涩；又用四物汤、黄芩、黄连、枳实之类的药，胸膈痞满，饮食减少，出汗如水；再用二陈汤、黄芩、黄连、黄柏、知母、麦冬、五味子，言语谵妄，两手挥舞。多次治疗反而加重。再次求我诊治，我用参、术各五钱，归、术各三钱，远志、茯神、枣仁、炙甘草各一钱，服用后熟睡良久，四剂后稍见安定，又用八珍汤调理而痊愈。所谓阴虚其实是肺虚，脾为至阴，因脾虚而导致上述症状。脾禀受于胃，所以用甘温的药剂，以生发胃中元气而除大热，为何反而用苦寒的药，再次损伤脾血呢？如果前述症状确实属于肾经阴虚，也只是因为肾经阳虚不能生阴罢了，更不宜用苦寒的药，应当用补中益气、六味地黄来补益其母。这是将脾虚误认为肾虚，就随意使用黄柏、知母之类的药，反而损伤胃中生发之气，害人多矣。大凡足三阴经虚，多因饮食劳役，导致肾不能生肝，肝不能生火，从而伤害脾土，不能滋养化源。只要补益脾土，则金旺水生，木得平而自相生矣。
一位儒者，素来勤劳刻苦，因饮食失节，大便下血，颜色或红或暗，半年之后，不是便血就是盗汗，不是恶寒就是发热，止血止汗药用之无效，六脉浮大，心脾脉涩。这是思虑伤心脾，不能摄血归源。然而血即汗，汗即血，其色赤黯，便血盗汗，都是火之升降微甚所致；恶寒发热，是气血俱虚。于是午前用补中益气汤，以补脾肺之源，提升下陷之气；午后用归脾汤加入麦冬、五味子，以补心脾之血，收敛耗散之液。不到两个月各种症状全部痊愈。
马生，发热烦渴，时而头痛，昨天用了发散药，反而加重喘急腹痛，其汗如水，昼夜谵语。我心想这是劳伤元气，误用汗法所致，其腹部心脏部位喜欢用手按压，询问果然如此，于是给予十全大补汤加入附子一钱，服用后熟睡，叫不醒，醒来后各种症状全部消退。再服两剂而痊愈。大凡人饮食劳倦，起居失宜，见到一切火症，都属于内真寒而外假热，所以肚腹喜欢温暖，口畏冷物。这是形气病气都不足，治法应当纯补上元气为好。
Wang Yongzhi, an official of the Qing Dynasty, suddenly suffered from stroke with coma, deviation of the mouth and eyes, surging phlegm-qi, rattling sound in the throat, and deep and hidden pulses in all six positions. This was due to deficiency of true qi with wind pathogen taking advantage of the weakness. He was administered San Sheng Yin (Three Lives Decoction) one tael, plus Ren Shen (Ginseng Root) one tael, decocted and taken orally, after which he regained consciousness immediately. If symptoms such as enuresis, hand relaxation (palms open), mouth opening, and snoring sleep appear, it is considered incurable; however, there are cases of survival even with the aforementioned medicine. San Sheng Yin is a formula that unblocks meridians and treats cold-phlegm, possessing the power of breaking through gates. Each dose must be accompanied by approximately one tael of Ren Shen (Ginseng Root) to control the pathogen and supplement true qi. Otherwise, not only will it be ineffective, but it may also lead to failure. Observing the ancients' use of formulas containing Fu Zi (Aconite Lateral Root) and Shen Fu Tang (Ginseng and Aconite Decoction), the principle becomes clear.
Jiang Dayong, a prefectural judge, had a robust physique, fullness in the middle jiao with expectoration, dizziness upon exertion, and had been taking medications for clearing phlegm and regulating qi. I stated: Fullness in the middle jiao is caused by spleen qi deficiency. Excessive phlegm results from the spleen's inability to transform and transport. Dizziness arises from the spleen's inability to raise clear yang. Numbness of the fingers indicates the spleen's inability to circulate qi throughout the body. Therefore, I prescribed Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fu Ling (Poria) and Ban Xia (Pinellia Tuber) to tonify the spleen earth, and Ba Wei Wan (Eight-Ingredient Pill) to tonify the mother of the spleen (kidney), resulting in recovery.
A male patient suddenly suffered from stroke with deviation of the mouth and eyes and aphasia. Upon exposure to wind-cold, his limbs became stiff and contracted, and his pulse was floating and tight. This indicated deficiency in the Hand and Foot Yangming meridians with wind-cold pathogen invading. Treatment with Qin Jiao (Radix Gentianae Macrophyllae) and Sheng Ma (Cimicifugae Rhizoma) led to slight improvement, followed by complete recovery using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shan Zhi (Gardeniae Fructus). If tongue aphasia prevents speech and leg flaccidity prevents walking, it belongs to kidney qi deficiency, named Fei Syndrome (Apoplexy with Flaccidity), and should be treated with Di Huang Yin Zi (Rehmannia Decoction).
A male patient, obese and fond of drinking, presented with a stiff tongue base, unclear speech, deviation of the mouth and eyes, surging phlegm-qi, and limb paralysis. I diagnosed this as spleen deficiency with damp-heat and prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) added with Wei Ge Gen (Baked Radix Puerariae), Shan Zhi (Gardeniae Fructus), and Shen Qu (Medicated Leaven), leading to recovery.
Gao Ruzhai, a censor, returned from Datong and told me: "I have developed wind disease. My legs are flaccid and weak when at rest, and painful like needle pricks when exerted. My pulse is flooding, rapid, and forceful." I said: "This is caused by yin deficiency of the liver and kidney with hyperactive fire. Flaccidity and weakness are the form of the true disease, while pain like cone insertion is the sign of evil fire." He recovered after taking herbs to nourish water and tonify the kidney.
Liu Mengchun, a county magistrate, had chronic phlegm, numbness in both arms, and tearing eyes. After taking wind-dispelling and phlegm-resolving medicines, his phlegm increased, his arms became painful and unable to extend, and his fingers contracted. I said: "Numbness belongs to qi deficiency. The previous medicines further injured the liver, causing fire hyperactivity and tendon contraction. Moreover, wind arises from fire. One should tonify the spleen and lung, and nourish kidney water, so that wind subsides, fire retreats, and phlegm clears." He was treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), recovering within three months.
Wang Ruhe, a jinshi degree holder, suddenly fell into a coma due to fatigue and lack of proper care. This was due to yuan qi (original qi) deficiency, with erratic movement of deficient fire carrying phlegm. He was urgently given Tong Bian (Child's Urine) to drink, and his mental clarity gradually improved. Subsequently, he took Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) each 5 qian, Chuan Xiong (Ligusticum Rhizome) and Dang Gui (Angelica Sinensis Root) each 3 qian, Xuan Shen (Scrophulariae Radix), Chai Hu (Bupleuri Radix), Shan Zhi (Gardeniae Fructus), and Zhi Gan Cao (Prepared Licorice Root) each 1 qian. His condition stabilized slightly. Observing his extreme fatigue, I prescribed Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Wu Wei Zi (Schisandra Fruit) and Mai Dong (Ophiopogon Tuber), leading to stability. This person had always had weak yuan qi. Whether due to improper daily routine, dietary fatigue, or excessive mental effort, he suffered from spermatorrhea and leukorrhea, spontaneous sweating, and night sweats; or internal heat, afternoon fever, tidal fever, and fever; or dry mouth with thirst, sore throat, and cracked tongue; or chest and breast distension, hypochondriac pain; or occasional head and neck pain, dizziness, and blurred vision; or restless mind, insomnia; or red and scanty urination with urethral pain; or dribbling after urination/defecation, coldness in the umbilical and abdominal region; or emaciation and aversion to cold in limbs; or rapid nasal breathing; or any other heat symptoms—all these are rootless deficient fire. By taking the aforementioned decoction to consolidate the root, all symptoms would subside. Attacking wind-heat would be a mistake.
Gao, an assistant director of the Court of Imperial Entertainments, had always had weak spleen and stomach. Due to dietary irregularities and fatigue, he experienced abdominal pain and chest oppression. Mistakenly using Da Huang (Rhubarb Rhizome) and other purgatives, he developed delirious speech, irritability, headache, panting, sweating, frequent vomiting and diarrhea, and occasional coma. His pulse was large and disordered. He was treated with Liu Jun Zi Tang (Six Gentlemen Decoction) added with Pao Jiang (Prepared Ginger), stabilizing after four doses. However, he remained fatigued with poor appetite, dry mouth, and fever, with floating and rapid pulses in all six positions. He desired to use fire-clearing medicines. I said: "Intermittent fever indicates no real fire (it is deficient fire); a floating and large pulse indicates blood deficiency; a floating and empty pulse indicates qi deficiency." This was due to stomach deficiency and loss of the five zang organs, manifesting as deficiency syndromes. Taking spleen and stomach-tonifying agents resolved all symptoms.
Xu Keming, a county magistrate, suffered from evening fever, dry mouth, fatigue, red and scanty urination, and soreness/pain in both legs due to improper diet. I treated him with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Being knowledgeable in medicine, he self-prescribed Si Wu Tang (Four Substance Decoction) with Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhenae Rhizoma). This resulted in dizziness, red eyes, tinnitus, dry lips, alternating chills and fever, surging phlegm, hot and painful defecation, and red/scanty urination. He then used Si Wu Tang (Four Substance Decoction) with Huang Qin (Scutellaria Root), Lian Zi (Lotus Plumule), and Zhi Shi (Immature Bitter Orange), leading to chest/diaphragm oppression and poor appetite, with profuse sweating like water. He subsequently used Er Chen Tang (Two Aged Ingredients Decoction) with Huang Qin (Scutellaria Root), Lian Zi (Lotus Plumule), Huang Bo (Phellodendron Bark), Zhi Mu (Anemarrhenae Rhizoma), Mai Dong (Ophiopogon Tuber), and Wu Wei Zi (Schisandra Fruit), resulting in delirious speech and waving of hands. Repeated treatments worsened his condition. Seeking my help again, I prescribed Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Rhizome) each 5 qian, Dang Gui (Angelica Sinensis Root) and Bai Zhu (Atractylodes Rhizome) each 3 qian, Yuan Zhi (Polygalae Radix), Fu Shen (Poria with Hostwood), Suan Zao Ren (Ziziphus Seed), and Zhi Gan Cao (Prepared Licorice Root) each 1 qian. He slept deeply after ingestion, stabilizing after four doses, and finally recovered with调理 (conditioning) using Ba Zhen Tang (Eight Treasure Decoction).所谓的 "yin deficiency" is actually lung deficiency; the spleen is the ultimate yin, and the aforementioned symptoms arise from spleen deficiency. The spleen derives from the stomach; therefore, sweet-warm agents are used to generate yuan qi in the stomach and eliminate great heat. Why use bitter-cold agents to injure spleen blood? If the aforementioned symptoms indeed belonged to kidney yin deficiency, it would merely be because kidney yang deficiency fails to generate yin. In such cases, bitter-cold agents are especially inappropriate. One should use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to tonify the mother. Mistaking spleen deficiency for kidney deficiency and arbitrarily using Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhenae Rhizoma) damages the generating qi of the stomach, harming many people. Generally, deficiency of the three foot yin meridians is often caused by dietary irregularities and labor, leading to the kidney failing to generate liver wood, the liver failing to generate fire, thereby injuring spleen earth and failing to nourish and transform. By tonifying spleen earth, metal becomes prosperous, water generates, wood is balanced, and mutual generation occurs naturally.
A scholar, accustomed to hard work, suffered from hematochezia (blood in stool) due to dietary irregularities, with blood color either bright red or dark. Half a year later, he alternated between hematochezia and night sweats, or aversion to cold and fever. Hemostatic and antiperspirant medicines were ineffective. His six pulses were floating and large, while the heart and spleen pulses were choppy. This was due to overthinking injuring the heart and spleen, failing to control blood and return it to its source. Blood is sweat, and sweat is blood; their red/dark color, along with hematochezia and night sweats, reflects the subtle variations in the ascending and descending of fire. Aversion to cold and fever indicate joint deficiency of qi and blood. Therefore, in the morning, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was used to tonify the source of spleen and lung and lift sunken qi; in the afternoon, Gui Pi Tang (Restore the Spleen Decoction) added with Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Fruit) was used to tonify heart and spleen blood and collect dissipating fluids. Within two months, all symptoms resolved.
Ma Sheng, a young man, suffered from fever, vexation, thirst, and occasional headache. Yesterday, dispersing medicines were used, which aggravated panting, abdominal pain, profuse sweating like water, and day-and-night delirium. I reasoned this was due to injury of yuan qi (original qi) from labor and mistaken sweating therapy. His abdomen and heart area preferred pressure, which was confirmed. I prescribed Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) added with Fu Zi (Aconite Lateral Root) 1 qian. He slept deeply, unresponsive to waking, and upon awakening, all symptoms had retreated. Two more doses led to recovery. For ordinary people, dietary irregularities and improper lifestyle leading to all kinds of "fire" symptoms belong to internal true cold and external false heat. Thus, the abdomen prefers warmth, and the mouth fears cold substances. This represents insufficiency of both form/qi and pathology/qi. The treatment method should be purely tonifying the upper yuan qi.