陈 三十二岁 甲寅年二月初四日 太阴所至，发为 胀者，脾主散津液，脾病不能散
津，
土曰敦阜，斯 胀矣。厥阴所至，发为 胀者，肝主疏泄，肝病不能疏泄，木穿土位，亦
胀矣。此症起于肝经郁勃，从头面肿起，腹因胀大，的系蛊胀，而非水肿，何以知之。满腹
青筋暴起如虫纹，并非本身筋骨之筋，故知之。治法行太阳之阳，泄厥阴之阴为要，医用八
味丸误治，反摄少阴之阴，又加牡蛎涩阴恋阳，使阳不得行，而阴凝日甚，六脉沉弦而细，
耳无所闻，目无所见，口中血块累累续出，经所谓血脉凝泣者是也。势太危极，不敢骤然用
药，思至阳而极灵者，莫如龙，非龙不足以行水，而开介属之翕，惟鲤鱼三十六鳞能化龙，
孙真人曾用之矣。但孙真人《千金》原方去鳞甲用醋煮，兹改用活鲤鱼大者一尾，得六斤不
去鳞甲，不破肚，加葱一斤，姜一斤，水煮熟透，加醋一斤，任服之。
服鲤鱼汤一昼夜，耳闻如旧，目视如旧，口中血块全无，神气清爽，但肿胀未除。
初五日 经谓病始于下而盛于上者，先治其下，后治其上，病始于上而盛于下者，先治
其上，后治其下，此病始于上肿，当发其汗，与《金匮》麻黄附子甘草汤。
麻黄（二两，去节） 熟附子（一两六钱） 炙甘草（一两二钱）
煮成五饭碗，先服半碗，得汗，止后服，不汗再服，以得汗为度。
此方甫立未分量，陈颂帚先生一见云∶断然无效。予问曰∶何以不效？陈先生云∶吾曾
用来
。予曰∶此在先生用，诚然不效，予用或可效耳。王先生名谟（忘其字）云∶吾甚不解，同一
方也，药止三味，并无增减，何以为吴用则利，陈用则否，岂无知之草木，独听吾兄使令哉
？予曰∶盖有故也。陈先生性情忠浓，其胆最小，伊芳恐麻黄发阳，必用八分，附子护阳，用
至一钱以监制，又恐麻黄、附子皆剽悍药也，甘草平缓，遂用一钱二分，又监制麻黄、附子
。服一帖无汗，改用八味丸矣，八味阴柔药多，乃敢大用，如何能效。病者乃兄陈荫山先生
入内室，取二十八日陈颂帚所用原方分量，一毫不差，在座者六七人，皆哗然笑曰∶何先生
之神也。予曰∶余常与颂帚先生一同医病，故知之深矣。于是麻黄去净节用二两，附子大者
一枚，得一两六钱，少麻黄四钱，让麻黄出头，甘草一两二钱，又少附子四钱，让麻黄、附
子出头，甘草但镇中州而已。众见分量，又大哗曰∶麻黄可如是用乎。颂帚先生云∶不妨，
如有过差，吾敢当之。众云∶君用八分，未敢足钱，反敢保二两之多乎。颂帚云∶吾在菊溪
先生处，治产后郁冒，用当归二钱，吴君痛责，谓当归血中气药，最能窜阳，产后阴虚阳越
，例在禁条，岂可用乎。夫麻黄之去当归，奚啻十百，吾用当归，伊芳责之甚，岂伊芳用麻黄又
如是之多，竟无定见乎。予曰∶人之畏麻黄如虎者，为其能大汗亡阳，未有汗不出而阳亡于
内者，汤虽多，但服一杯，或半杯，得汗即止，不汗再服，不可使汗淋漓，何畏其亡阳哉。
但此症闭锢已久，阴霾太重，虽尽剂未必有汗。予明日再来发汗，病家始敢买药，而仙芝堂
药铺竟不卖，谓想是钱字，先生误写两字，主人亲自去买，方得药。服尽剂，竟无汗。
初六日 众人见汗不出，佥谓汗不出者死，此症不可为矣。余曰不然，若竟死症，鲤鱼
汤不
见效矣。予化裁仲景先师桂枝汤，用粥发胃家汗法，竟用原方分量一帖，再备用一帖。又用
活鲤鱼一尾，得重四斤，煮如前法，服麻黄汤一饭碗，即接服鲤鱼汤一碗，汗至眉上；又一
次，汗出上眼皮；又一次，汗至下眼皮；又一次，汗至鼻；又一次，汗至上唇。大约每一次
，汗出三寸许，二帖俱服完。鲤鱼汤一锅，喝一昼夜，亦服尽，汗至伏兔而已，未过膝也，
脐以上肿俱消，腹仍大。
初七日 经谓汗出不止足者死，此症尚未全活，虽腰以上肿消，而腹仍大，腰以下其肿
如故
，因用腰以下肿，当利小便例，与五苓散，服至二十一日共十五天不效，病亦不增不减。陈
荫山先生云∶前用麻黄，其效如神，兹小便滴不下，奈何，祈转方。予曰∶病之所以不效者
，药不精良耳。今日先生去求好肉桂，若仍系前所用之桂，明日予不能立方，固无可转也。
二十二日 陈荫山购得新鲜紫油边青花桂一枝，重八钱，乞予视之。予曰∶得此桂必有
小便
，但恐脱耳。膀胱为州都之官，气化则能出焉，气虚亦不能化，于是用五苓二两，加桂四钱
，顶高辽参三钱，服之尽剂，病者所睡系棕床，予嘱备大盆二三枚，置之床下，溺完被湿不
可动，俟明日予亲视挪床，其溺自子正始通，至卯正方完，共得溺大盆有半。予辰正至其家
，视其周身如空布袋，又如腐皮，于是用调理脾胃痊愈。
洪氏 六十八岁 孀居三十余年，体浓忧郁太多，肝经郁勃久矣，又因暴怒重忧，致成
厥阴
太阴两经 胀并发，水不得行，肿从跗起，先与腰以下肿，当利小便例之五苓散法，但阴气
太重，六脉沉细如丝，断非轻剂所能了。
桂枝（五钱） 生苍术（五钱） 猪苓（五钱） 泽泻（五钱） 茯苓皮（六钱） 肉桂（四钱）
广皮（五钱） 浓朴（四钱）
前方服三五帖不效，亦无坏处，小便总不见长，肉桂加至二三两，桂枝加至四五两，他
药称
是，每剂近一斤之多，作五六碗，服五七帖后，六脉丝毫不起，肿不消，便亦不长。所以然
之故，肉桂不佳，阴气太重，忧郁多年，暴怒伤肝，必有陈菀。仍用原方加鸡矢醴熬净烟六
钱，又加附子八钱，服之小便稍通，一连七帖，肿渐消，饮食渐进，形色渐喜。于是渐减前
方分量，服至十四帖，肿胀全消。后以补脾阳，疏肝郁收功。
郭氏 六十二岁 先是郭氏丧夫于二百里外其祖墓之侧，郭携子奔丧，饥不欲食，寒不
欲衣
，悲痛太过，葬后庐墓百日，席地而卧，哭泣不休，食少衣薄，回家后致成单腹胀，六脉弦
，无胃气，气喘不能食，唇舌刮白，面色淡黄，身体羸瘦。余思无情之草木，不能治有情之
病，必得开其愚蒙，使情志畅遂，方可冀见效于万一。因问曰∶汝之痛心疾首，十倍于常人
者何故？伊芳答曰∶夫死不可复生，所遗二子，恐难立耳。余曰∶汝何不明之甚也。大凡妇人
夫死，曰未亡人，言将待死也。汝如思夫愈切，即死墓侧，得遂同穴之情，则亦已矣。虽有
病何必医，医者求其更苏也。其所以不死者，仍系相夫之事业也。汝子之父已死，汝子已失
其荫，汝再死，汝子岂不更无所赖乎。汝之死，汝之病，不惟无益于夫，而反重害其子，害
其子，不惟无益于子，而且大失夫心。汝此刻欲尽
妇人之道，必体亡夫之心，尽教子之职，汝必不可死也。不可死，且不可病，不可病，必得
开怀畅遂，而后可愈。单腹胀，死症也。脉无胃气，死脉也。以死症而见死脉，必得心火旺
，折泄肝郁之阴气，而后血脉通，血脉通，脏气遂，死证亦有可生之道。诗云∶见 曰
消者
是也。伊芳闻余言大笑，余曰∶笑则生矣。伊芳云∶自此以后，吾不惟不哭，并不敢忧思，一味
以喜乐从事，但求其得生，以育吾儿而已。余曰∶汝自欲生则生矣。于是为之立开郁方，十
数剂而收全功。
旋复花（三钱，新绛纱包） 降香末（三钱） 归须（二钱） 苏子霜（三钱） 郁金（三钱）
香附（三钱） 川浓朴（三钱） 姜半夏（四钱） 广皮（三钱） 青橘皮（二钱）
吴氏 二十八岁 春夏间乘舟，由南而北，途间温毒愈后，感受风湿，内胀外肿，又有
肝郁
之过，时当季夏，左手劳宫穴，忽起劳宫毒，如桃大。此症治热碍湿，治湿碍热之弊，选用
幼科痘后余毒归肺，喘促咳逆之实脾利水法，加极苦合为苦淡法，俾热毒由小肠下入膀胱，
随湿热一齐泄出也。盖劳宫毒属心火，泻心者必泄小肠，小肠火腑，非苦不通。腰以下肿，
当利小便，利小便者，亦用苦淡也。
猪苓（一两） 茯苓皮（一两） 白通草（三钱） 泽泻（一两） 晚蚕砂（二两） 雅连（四钱）
黄柏（四钱） 飞滑石（四钱） 黄芩（四钱）
煮成五碗，分五次服，以小便长者为度，此方服七帖，分量不增减，肿胀与劳宫毒俱消
，以后补脾收功。
陈 二十六岁 乙酉年五月十五日 脉弦细而紧，不知饥，内胀外肿，小便不利，与腰
以下
肿当利小便法，阳欲灭绝，重加热以通阳，况今年燥金，太乙天符，经谓必先岁气，毋伐天
和。
桂枝（六钱） 猪苓（五钱） 生茅术（三钱） 泽泻（五钱） 广橘皮（三钱） 川椒炭（五钱）
浓朴（四钱） 茯苓皮（六钱） 公丁香（二钱） 杉木皮（一两）
煮四杯，分四次服。
二十五日 诸症皆效，知饥，肿胀消其大半。惟少腹有疝，竟如有一根筋吊痛，于原方
内减丁香一钱，加小茴香三钱。
单氏 四十二岁 肿胀六年之久，时发时止，由于肝郁，应照厥阴 胀例治。
降香末（三钱） 木通（二钱） 香附（三钱） 旋复花（三钱） 归须（三钱） 郁金（二钱）
青皮（二钱） 浓朴（三钱） 大腹皮（三钱） 云苓（六钱） 半夏（四钱）
煮成三杯，分三次服，不能宽怀消怒，不必服药。
二十六日 服前方八帖，肿胀稍退。惟阳脉微弱，加以椒炭三钱；大便不通，加两头尖
三钱，去陈菀。
陈，三十二岁。甲寅年二月初四日就诊。
太阴湿土之气所至，引发胀满病证者，因脾主运化散津液，若脾病不能正常散津，则土气过盛（敦阜），从而产生胀满。厥阴风木之气所至，引发胀满病证者，因肝主疏泄，若肝病不能疏泄，则木气穿克土位，亦会产生胀满。此症起于肝经郁结勃发，从头面部开始肿胀，腹部随之胀大，确系蛊胀（一种以腹部胀大如鼓、青筋暴露为特征的积聚病），而非水肿。何以得知？因为满腹青色筋脉暴起，状如虫纹，并非人体正常的筋骨之筋，故可判断。治疗关键在于通调太阳经之阳气，疏泄厥阴经之阴邪。此前医生误用八味丸治疗，反而收敛了少阴之阴，又加入牡蛎涩敛阴气、留恋阳气，致使阳气无法运行，阴凝日益严重。患者六脉沉弦而细，耳无所闻，目无所见，口中不断吐出血块，这正是《内经》所说的“血脉凝泣”之象。病情极其危重，不敢贸然用药。思至极阳且极灵动的药物，莫过于龙，非龙不足以行水并开启介类动物的闭阻。只有三十六鳞的鲤鱼能化为龙，孙思邈曾使用过此法。但孙思邈《千金方》原方是去掉鳞甲用醋煮，现改用活的大鲤鱼一条，重六斤，不去鳞甲，不破肚，加葱一斤，姜一斤，水煮至熟透，再加醋一斤，让患者随意服用。
服用鲤鱼汤一昼夜后，听力恢复如常，视力恢复如常，口中不再吐血块，神气清爽，但肿胀未消除。
初五日。《内经》说：病始于下部而盛于上部的，先治下部，后治上部；病始于上部而盛于下部的，先治上部，后治下部。此病始于上部头面肿胀，应当发汗，给予《金匮要略》中的麻黄附子甘草汤。
麻黄（二两，去节） 熟附子（一两六钱） 炙甘草（一两二钱）
煮成五饭碗药液，先服半碗，得汗则停服后续药，无汗则再服，以得汗为标准。
此方刚拟定尚未称量时，陈颂帚先生一见便说：“肯定无效。”我问：“为何无效？”陈先生答：“我曾用过。”我说：“这方子在先生手中用，确实无效，在我手中用或许有效。”王先生名谟（忘记他的字）说：“我很不解，同一张方子，药只有三味，并无增减，为何吴先生用则有效，陈先生用则无效？难道草木无知，只听我兄长使唤吗？”我说：“是有原因的。陈先生性情忠厚浓烈，胆子最小，他恐怕麻黄发散阳气，必只用八分；附子护阳，用到一钱以监制；又恐麻黄、附子都是剽悍之药，甘草平缓，遂用一钱二分，再次监制麻黄、附子。服一帖无汗，便改用八味丸了。八味丸多为阴柔之药，他才敢大量使用，如何能生效？患者的兄长陈荫山先生进入内室，取出二十八日陈颂帚所用的原方分量，一毫不差。在座者六七人，都哗然笑道：‘何先生如此神机妙算！’我说：‘我常与颂帚先生一同医病，所以知之甚深。’于是确定麻黄去净节用二两，附子大者一枚，得一两六钱，比原方少麻黄四钱，让麻黄出头（发挥主要作用）；甘草一两二钱，又少附子四钱，让麻黄、附子出头，甘草仅镇守中州而已。众人见到分量，又大哗道：‘麻黄可以这样用吗？’颂帚先生说：‘不妨事，如有差错，我敢承担。’众人说：‘你以前用八分都不敢足钱，现在竟敢保证用二两之多吗？’颂帚说：‘我在菊溪先生处，治疗产后郁冒，用当归二钱，吴君痛责，谓当归是血中气药，最能窜动阳气，产后阴虚阳越，例在禁条，岂可用乎。夫麻黄之害比起当归，何止十倍百倍，我用当归，他责备得很厉害，难道他用麻黄又是这么多，竟然没有定见吗？’我说：‘人们畏惧麻黄如虎，是因为它能导致大汗亡阳，却从未见过无汗而出内亡阳的。汤药虽多，但只服一杯或半杯，得汗即止，无汗再服，不可使汗淋漓，何必畏惧亡阳呢？但这症闭锢已久，阴霾太重，即使服完全部药剂也未必有汗。我明日再来发汗。’病家这才敢买药，而仙芝堂药铺竟不卖，说是想是钱字，先生误写成了两字。主人亲自去买，才买到药。服完全部药剂，竟然无汗。
初六日。众人见汗不出，都说汗不出者死，此症不可救了。我说：不对，若是死症，鲤鱼汤就不会见效了。我化裁仲景先师的桂枝汤，采用喝粥以发胃气之汗的方法，竟用原方分量一帖，再备用一帖。又用活鲤鱼一条，重四斤，按前法煮，服麻黄汤一饭碗，随即接服鲤鱼汤一碗，汗出至眉毛上方；又一次，汗出至上眼皮；又一次，汗出至下眼皮；又一次，汗出至鼻子；又一次，汗出至上唇。大约每一次汗出约三寸许，两帖药全部服完。鲤鱼汤一锅，喝了一昼夜，也服尽了，汗出至伏兔穴位置，未过膝盖，脐以上肿胀全消，腹部仍然胀大。
初七日。《内经》说：汗出不止足者死，此症尚未全愈，虽然腰以上肿消，而腹部仍大，腰以下肿胀依旧，因此依据“腰以下肿，当利小便”的原则，给予五苓散，服用至二十一日共十五天，无效，病情也不增不减。陈荫山先生说：“前用麻黄，其效如神，如今小便滴不下，怎么办？请转方。”我说：“病之所以无效，是因为药材不精良。今日先生去寻找好肉桂，如果仍是之前所用的桂，明日我不能开方，确实无可转方。”
二十二日。陈荫山购得新鲜紫油边青花桂一枝，重八钱，乞求我看诊。我说：“得到此桂必有小便，但恐怕会脱证。”膀胱为州都之官，气化则能出焉，气虚也不能化气，于是用五苓散二两，加肉桂四钱，顶高辽参三钱，服尽药剂。病人所睡的是棕床，我嘱咐准备大盆二三枚，置于床下，尿完被湿不可移动，等明天我亲自查看挪床。尿液自子时开始通畅，至卯时才排完，共得尿大半盆。我辰时到其家，视其周身如空布袋，又如腐皮，于是用调理脾胃之法痊愈。
洪氏，六十八岁。寡居三十余年，体态丰腴，忧郁过多，肝经郁结已久，又因暴怒重忧，导致厥阴、太阴两经胀满并发，水液不得运行，肿胀从足背发起。先依据“腰以下肿，当利小便”的原则，给予五苓散法，但阴气太重，六脉沉细如丝，断非轻剂所能治愈。
桂枝（五钱） 生苍术（五钱） 猪苓（五钱） 泽泻（五钱） 茯苓皮（六钱） 肉桂（四钱） 广陈皮（五钱） 厚朴（四钱）
前方服用三五帖无效，也无坏处，小便总不见长。肉桂加至二三两，桂枝加至四五两，其他药物按比例增加，每剂近一斤之多，作五六碗，服用五七帖后，六脉丝毫不起，肿不消，便亦不长。之所以如此，是因为肉桂不佳，阴气太重，忧郁多年，暴怒伤肝，必有陈旧瘀滞。仍用原方加鸡矢醴熬净烟六钱，又加附子八钱，服用后小便稍通，一连七帖，肿胀渐消，饮食渐进，神色渐喜。于是逐渐减少前方分量，服用至十四帖，肿胀全消。后以补脾阳、疏肝郁收功。
郭氏，六十二岁。起初郭氏在二百里外的祖墓旁丧夫，郭氏携子奔丧，饥饿不想进食，寒冷不想穿衣，悲痛太过，葬后在墓旁庐舍百日，席地而卧，哭泣不休，食少衣薄，回家后致成单腹胀（腹部胀大，四肢消瘦）。六脉弦，无胃气，气喘不能食，唇舌刮白，面色淡黄，身体羸瘦。我思惟无情之草木，不能治有情之病，必须开导其愚蒙，使情志畅遂，方可冀望万一见效。于是问：“你痛心疾首，十倍于常人，是何缘故？”她回答：“丈夫死了不能再复生，所遗两个儿子，恐怕难以自立罢了。”我说：“你怎么如此不明智。大凡妇人夫死，称为‘未亡人’，意思是等待死去。你若思念丈夫愈切，就死在墓旁，得以遂同穴之情，也就罢了。虽有病何必医，医者求其更苏也。其所以不死者，仍系相夫之事业也。汝子之父已死，汝子已失其荫，汝再死，汝子岂不更无所赖乎。汝之死，汝之病，不惟无益于夫，而反重害其子，害其子，不惟无益于子，而且大失夫心。汝此刻欲尽妇人之道，必体亡夫之心，尽教子之职，汝必不可死也。不可死，且不可病，不可病，必得开怀畅遂，而后可愈。单腹胀，死症也。脉无胃气，死脉也。以死症而见死脉，必得心火旺，折泄肝郁之阴气，而后血脉通，血脉通，脏气遂，死证亦有可生之道。诗云：‘见笑曰消者’是也。”她听我言大笑，我说：“笑则生矣。”她说：“自此以后，我不惟不哭，并不敢忧思，一味以喜乐从事，但求其得生，以育吾儿而已。”我说：“汝自欲生则生矣。”于是为之立开郁方，十数剂而收全功。
旋复花（三钱，新绛纱包） 降香末（三钱） 归须（二钱） 苏子霜（三钱） 郁金（三钱） 香附（三钱） 川厚朴（三钱） 姜半夏（四钱） 广陈皮（三钱） 青橘皮（二钱）
吴氏，二十八岁。春夏间乘舟，由南而北，途中温毒愈后，感受风湿，内胀外肿，又有肝郁之过。时当季夏，左手劳宫穴，忽起劳宫毒，如桃大。此症治热碍湿，治湿碍热之弊，选用幼科痘后余毒归肺，喘促咳逆之实脾利水法，加极苦合为苦淡法，俾热毒由小肠下入膀胱，随湿热一齐泄出也。盖劳宫毒属心火，泻心者必泄小肠，小肠火腑，非苦不通。腰以下肿，当利小便，利小便者，亦用苦淡也。
猪苓（一两） 茯苓皮（一两） 白通草（三钱） 泽泻（一两） 晚蚕砂（二两） 雅连（四钱） 黄柏（四钱） 飞滑石（四钱） 黄芩（四钱）
煮成五碗，分五次服，以小便长者为度，此方服七帖，分量不增减，肿胀与劳宫毒俱消，以后补脾收功。
陈，二十六岁。乙酉年五月十五日。脉弦细而紧，不知饥，内胀外肿，小便不利，与腰以下肿当利小便法，阳欲灭绝，重加热以通阳，况今年燥金，太乙天符，经谓必先岁气，毋伐天和。
桂枝（六钱） 猪苓（五钱） 生茅术（三钱） 泽泻（五钱） 广橘皮（三钱） 川椒炭（五钱） 厚朴（四钱） 茯苓皮（六钱） 公丁香（二钱） 杉木皮（一两）
煮四杯，分四次服。
二十五日。诸症皆效，知饥，肿胀消其大半。惟少腹有疝，竟如有一根筋吊痛，于原方内减丁香一钱，加小茴香三钱。
单氏，四十二岁。肿胀六年之久，时发时止，由于肝郁，应照厥阴胀例治。
降香末（三钱） 木通（二钱） 香附（三钱） 旋复花（三钱） 归须（三钱） 郁金（二钱） 青皮（二钱） 厚朴（三钱） 大腹皮（三钱） 云苓（六钱） 半夏（四钱）
煮成三杯，分三次服，不能宽怀消怒，不必服药。
Chen, aged 32. Consulted on the 4th day of the 2nd month in the Jiayin year.
When Taiyin (Spleen/Stomach) damp-earth qi prevails, it manifests as distension. The Spleen governs the distribution of fluids; if Spleen disease prevents fluid distribution, Earth qi becomes excessive (Dunfu), leading to distension. When Jueyin (Liver/Gallbladder) wind-wood qi prevails, it also manifests as distension. The Liver governs free flow and drainage; if Liver disease impairs free flow, Wood qi penetrates and overacts on Earth, also causing distension. This case originated from stagnation and exuberance in the Liver channel, starting with swelling of the head and face, followed by abdominal distension. It is indeed Gu Distension (a type of accumulation characterized by a drum-like abdomen and visible veins), not Edema. How do I know? Because green veins bulge across the entire abdomen like worm patterns, which are not normal tendons or bones of the body. The treatment principle is to regulate the Yang of the Taiyang channel and drain the Yin of the Jueyin channel. Previously, physicians mistakenly used Bawei Wan (Eight-Ingredient Pill with Rehmannia Root), which instead retained Shaoyin Yin, and added Mother-of-Pearl Shell (Muli) to astringe Yin and detain Yang, preventing Yang from moving and causing Yin coagulation to worsen daily. The six pulses were deep, wiry, and thin; hearing was impaired, vision was obscured, and blood clumps continuously spat from the mouth. This corresponds to what the Classic describes as "coagulation and stagnation of the blood vessels." The condition was extremely critical, so I dared not administer medication abruptly. Reflecting on the most extreme Yang and most agile substance, nothing surpasses the Dragon. Only the Dragon can move water and open the closure of shellfish-type entities. Among them, only the carp with thirty-six scales can transform into a Dragon. Sun Simiao once used this method. However, Sun’s original formula in *Qianjin Fang* removed scales and shells and boiled them in vinegar. Here, I changed it to one large live carp weighing six jin, keeping scales and shells intact, not breaking the belly, adding one jin of Scallion Stem (Cong Bai) and one jin of Ginger (Sheng Jiang), boiling until thoroughly cooked, then adding one jin of Vinegar (Cu), allowing the patient to consume it freely.
After consuming the Carp Decoction for one day and night, hearing returned to normal, vision returned to normal, no more blood clumps were spat from the mouth, and mental energy became clear, but the swelling remained.
On the 5th day: The Classic states: If a disease starts below and intensifies above, treat the lower part first, then the upper; if it starts above and intensifies below, treat the upper part first, then the lower. Since this disease started with upper-body swelling, sweating should be induced using Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction) from *Jingui Yaolue*.
Mahuang (Ephedrae Herba) (2 liang, nodes removed) Shu Fuzi (Prepared Radix Aconiti Lateralis) (1 liang 6 qian) Zhi Gancao (Honey-fried Radix Glycyrrhizae) (1 liang 2 qian).
Boil to yield five rice bowls of liquid. Take half a bowl first; if sweat occurs, stop subsequent doses; if no sweat, take again. The goal is to achieve sweating.
When the formula was just drafted and not yet weighed, Mr. Chen Songzhou saw it and said, "It will certainly be ineffective." I asked, "Why?" He replied, "I have used it." I said, "For you, it may indeed be ineffective, but for me, it might work." Mr. Wang Mo (name only, courtesy name forgotten) said, "I do not understand. It is the same formula, only three herbs, no additions or subtractions. Why does it benefit when used by Wu, but fail when used by Chen? Do plants lack knowledge and obey only my brother?" I said, "There is a reason. Mr. Chen is loyal and thick-natured but has very little courage. He fears Mahuang dispersing Yang, so he uses only 8 fen. He uses Fuzi to protect Yang, up to 1 qian to control it. Fearing both Mahuang and Fuzi are fierce drugs, and Gancao is mild, he uses 1.2 qian to further control them. After one dose yielded no sweat, he switched to Bawei Wan. Bawei Wan contains many Yin-nourishing herbs, so he dares to use large doses. How could it be effective? The patient's elder brother, Mr. Chen Yingshan, went into the inner room, retrieved the original prescription weights used by Chen Songzhou on the 28th, down to the smallest unit. The six or seven people present laughed loudly, 'How divine your insight is!' I said, 'I often treat diseases with Mr. Songzhou, so I know him well.' Thus, we determined: Mahuang, nodes completely removed, 2 liang; one large Fuzi, yielding 1 liang 6 qian; reduce Mahuang by 4 qian to let Mahuang lead; Gancao 1 liang 2 qian, reduce Fuzi by 4 qian to let Mahuang and Fuzi lead, while Gancao merely stabilizes the Middle Jiao. Seeing the weights, everyone exclaimed again, 'Can Mahuang be used like this?' Mr. Songzhou said, "No harm. If there is an error, I will take responsibility." Others said, "You didn't dare to add even a coin's weight to 8 fen before, now you dare guarantee 2 liang?" Mr. Songzhou said, "When I treated postpartum depression under Mr. Ju Xi, I used Dang Gui 2 qian. Wu severely criticized me, saying Dang Gui is a Qi-moving herb within Blood, capable of stirring Yang excessively. Postpartum Yin deficiency with Yang floating is a contraindication. How could it be used? The danger of Mahuang compared to Dang Gui is ten or a hundred times greater. He criticized me heavily for using Dang Gui; how can he use such a large amount of Mahuang without a fixed principle?" I said, "People fear Mahuang like tigers because it causes profuse sweating and loss of Yang. Yet, I have never seen internal Yang loss without sweating. Although the decoction volume is large, take only one cup or half a cup; stop upon sweating, take again if no sweat. Do not allow dripping sweat. Why fear Yang loss? But this case has been closed for a long time, with heavy Yin-cold. Even finishing the dose may not produce sweat. I will return tomorrow to induce sweating." The family finally dared to buy medicine, but Xianzhitang Pharmacy refused to sell, claiming the character for 'liang' was likely a mistake for 'qian'. The owner bought it personally. After finishing the full dose, there was still no sweat.
On the 6th day: Seeing no sweat, everyone agreed that no sweat means death, and the case was hopeless. I said, "Incorrect. If it were truly terminal, the Carp Decoction would not have shown effect. I modified Zhongjing’s Guizhi Tang (Cinnamon Twig Decoction), employing the method of drinking congee to induce stomach-Qi sweating. I used the original dosage for one dose, with another ready. Also, one live carp weighing four jin, boiled as before. After taking one bowl of Mahuang Tang, immediately follow with one bowl of Carp Decoction. Sweat appeared above the eyebrows; next, on the upper eyelids; next, on the lower eyelids; next, on the nose; next, on the upper lip. Approximately three cun of sweat per episode. Both doses were finished. The pot of Carp Decoction was consumed over one day and night. Sweat reached the Futu point (ST32), not passing the knee. Swelling above the navel disappeared, but the abdomen remained distended.
On the 7th day: The Classic says: Unremitting sweating leads to death. This case is not fully recovered. Although swelling above the waist subsided, the abdomen remains large, and swelling below the waist persists. Therefore, following the principle "swelling below the waist requires promoting urination," I prescribed Wuling San (Five-Ingredient Powder with Poria). Taken until the 21st day (15 days total), it was ineffective, and the condition neither improved nor worsened. Mr. Chen Yingshan said, "The previous Mahuang worked miraculously. Now urine drops cannot pass. Please change the formula." I said, "The ineffectiveness is due to poor quality herbs. Today, please seek good Rou Gui (Cinnamon Bark). If it is the same as before, I cannot prescribe anything new tomorrow."
On the 22nd day: Chen Yingshan purchased a branch of fresh Purple-Oil Edge Blue-Flower Cinnamon weighing 8 qian. I examined it and said, "With this cinnamon, there will be urination, but beware of collapse." The Bladder is the Officer of the Metropolis; Qi transformation allows excretion. Qi deficiency also prevents transformation. Thus, I used Wuling San 2 liang, added Rou Gui 4 qian, and top-grade Liao Shen (Codonopsis Pilosula) 3 qian. Finished the dose. The patient slept on a palm-fiber bed. I instructed preparing two or three large basins under the bed. Do not move the bed until urination finishes and wets the bedding; wait for me to inspect and move the bed tomorrow. Urination started at Zi hour (23:00-01:00) and finished at Mao hour (05:00-07:00), totaling half a large basin. Arriving at his home at Chen hour (07:00-09:00), I observed his whole body looked like an empty cloth bag or dried skin. Then, I used a Spleen-Stomach regulating method to cure him.
Hong, aged 68. Widowed for over 30 years, obese constitution, excessive melancholy, leading to long-term Liver stagnation. Due to sudden anger and severe worry, Jueyin and Taiyin distension occurred simultaneously. Water failed to circulate, swelling started from the dorsum of the foot. Initially applying the principle "swelling below the waist requires promoting urination" with Wuling San method, but Yin-cold was too heavy, six pulses were deep and thin like threads. Light doses certainly could not resolve it.
Guizhi (Ramulus Cinnamomi) (5 qian) Sheng Cangzhu (Rhizoma Atractylodis Lanceae) (5 qian) Zhuling (Polyporus) (5 qian) Zexie (Radix Alismatis) (5 qian) Fulingpi (Exocarpus Citri Grandis - note: text says Fulingpi but ingredient list implies Poria skin or similar diuretic context, usually Fuling is Poria; here strictly translating ingredient names provided) (6 qian) Rou Gui (Cortex Cinnamomi) (4 qian) Guangpi (Pericarpium Citri Reticulatae) (5 qian) Houpo (Cortex Magnoliae Officinalis) (4 qian).
The previous formula taken for 3-5 doses was ineffective but harmless; urine did not increase. Rou Gui increased to 2-3 liang, Guizhi to 4-5 liang, other herbs proportionally increased. Each dose nearly 1 jin, made into 5-6 bowls. After 5-7 doses, six pulses remained undetectable, swelling persisted, urine did not increase. The reason: poor quality Rou Gui, heavy Yin-cold, years of melancholy, sudden anger injuring Liver, resulting in old stasis. Still using the original formula, added Jishi Li (Feces Gallinae Fermentatum) smoke residue 6 qian, and added Fuzi 8 qian. Urine slightly increased after taking. Seven consecutive doses, swelling gradually subsided, diet gradually improved, complexion brightened. Gradually reduced dosages, finished in 14 doses, swelling completely resolved. Finally concluded with tonifying Spleen-Yang and soothing Liver-stagnation.
Guo, aged 62. Initially, Guo lost her husband 200 li away near the ancestral tomb. She brought her son to mourn, hungry but refusing food, cold but refusing clothes, grief exceeding limits. After burial, she lived in a hut by the tomb for 100 days, sleeping on the ground, crying incessantly, eating little, wearing thin clothes. Returning home, she developed Single Abdominal Distension (monadic abdominal distension). Six pulses were wiry, lacking Stomach-Qi. Panting, unable to eat, lips and tongue coated white, pale yellow complexion, emaciated body. I reasoned that heartless herbs cannot treat heart-sick patients. One must enlighten their ignorance, smooth their emotions, to hope for any effect. I asked, "Why is your heartache ten times worse than others?" She answered, "My husband died and cannot return. My two remaining sons fear they cannot stand on their own." I said, "How ignorant you are. Generally, a widow calls herself 'Weiwangren' (not yet dead), implying waiting to die. If you miss your husband deeply, dying by the tomb to join him in the grave would suffice. Why seek medical treatment? Doctors seek recovery. The reason you haven't died is your duty to support your husband. Your son's father is dead; your son has lost his protection. If you die, your son will have no reliance. Your death and illness not only benefit no one but harm your son greatly. Harming your son benefits no one and grieves your husband deeply. To fulfill your role as a wife, you must embody your late husband's heart and fulfill your duty to teach your son. You must not die. Not die, not sick. Not sick requires opening your heart and smoothing emotions to heal. Single Abdominal Distension is a fatal sign. Pulse lacking Stomach-Qi is a fatal pulse. With fatal signs and fatal pulse, Heart-Fire must be strengthened to suppress Liver-stagnant Yin-Qi. Then blood vessels unblock, Zang-Qi flows, and fatal cases may survive. The Poem says: 'Seeing laughter indicates dissipation.'" She heard my words and laughed loudly. I said, "Laughter brings life." She said, "From now on, I will not cry, nor worry. I will solely pursue joy, seeking life to raise my son." I said, "If you desire life, you will live." Thus, I prescribed a formula to open stagnation. Over ten doses, full recovery was achieved.
Xuanfuhua (Flos Inulae, wrapped in Xinjiang Sha) (3 qian) Jiangxiangmo (Lignum Dalbergiae Odoriferae Powder) (3 qian) Guixu (Radix Angelicae Sinensis Tail) (2 qian) Suzishuang (Fructus Perillae Frutescentis Frost) (3 qian) Yujin (Radix Curcumae Longae) (3 qian) Xiangfu (Rhizoma Cyperi Rotundi) (3 qian) Chuan Houpo (Cortex Magnoliae Officinalis) (3 qian) Jiang Banxia (Rhizoma Pinelliae Ternatae Prepared with Ginger) (4 qian) Guangpi (Pericarpium Citri Reticulatae) (3 qian) Qingjupi (Pericarpium Citri Reticulatae Viride) (2 qian).
Wu, aged 28. During spring and summer, traveling by boat from south to north, after recovering from Warm-Toxin, contracted Wind-Dampness. Internal distension and external swelling, compounded by Liver-stagnation. Season was early summer. Suddenly, Laogong Poison (Acupoint PC8) erupted on the left hand, size of a peach. This case involves treating Heat obstructing Dampness and Dampness obstructing Heat. Selected the pediatric method for residual toxins after smallpox returning to the Lung, causing panting and cough, using Shi Pi Li Shui (Solidify Spleen and Promote Urination) method, combined with extreme bitter and bland flavors, allowing Heat-Toxin to descend via Small Intestine into Bladder, draining out with Damp-Heat. Laogong Poison belongs to Heart-Fire. Clearing Heart requires draining Small Intestine. Small Intestine is the Fire Fu organ, requiring bitterness to unblock. Swelling below the waist requires promoting urination, which also uses bitter-bland methods.
Zhuling (Polyporus) (1 liang) Fulingpi (Poria Skin) (1 liang) Baigengtong (Herba Tetrasii) (3 qian) Zexie (Radix Alismatis) (1 liang) Wancan Sha (Spuma Bombycis Batryticatus) (2 liang) Yalian (Rhizoma Coptidis Chinensis) (4 qian) Huangbai (Cortex Phellodendri Amurensis) (4 qian) Fei Huashi (Talcum) (4 qian) Huangqin (Radix Scutellariae Baicalensis) (4 qian).
Boil to five bowls, divide into five doses. Goal is increased urination. Seven doses taken, weights unchanged. Swelling and Laogong Poison both cleared. Concluded with tonifying Spleen.
Chen, aged 26. May 15th, Yiyou year. Pulses wiry, thin, and tight. No hunger sensation, internal distension, external swelling, difficult urination. Applied the method "swelling below the waist requires promoting urination." Yang was about to extinguish, heavily heated to unblock Yang. Moreover, this year is Dry Metal, Taiyi Tianfu pattern. The Classic says: First consider the annual Qi, do not violate Heavenly Harmony.
Guizhi (Ramulus Cinnamomi) (6 qian) Zhuling (Polyporus) (5 qian) Sheng Maozhu (Rhizoma Atractylodis Macrocephalae Raw) (3 qian) Zexie (Radix Alismatis) (5 qian) Guangjupi (Pericarpium Citri Reticulatae) (3 qian) Chuan Jiaotan (Carbonized Fructus Zanthoxylli Schinzi) (5 qian) Houpo (Cortex Magnoliae Officinalis) (4 qian) Fulingpi (Poria Skin) (6 qian) Gong Dingxiang (Flos Caryophylli) (2 qian) Shanmupi (Cortex Tugitae) (1 liang).
Boil to four cups, divide into four doses.
25th Day: All symptoms responded. Hunger returned, swelling reduced by more than half. Only minor abdominal hernia pain, feeling like a tendon pulling. Reduced Dingxiang by 1 qian, added Xiaohui Xiang (Fructus Foeniculi) 3 qian in the original formula.
Dan, aged 42. Swelling for six years, intermittent, due to Liver-stagnation. Should be treated according to Jueyin Distension principles.
Jiangxiangmo (Lignum Dalbergiae Odoriferae Powder) (3 qian) Mutong (Caulis Akebiae Trifoliatae) (2 qian) Xiangfu (Rhizoma Cyperi Rotundi) (3 qian) Xuanfuhua (Flos Inulae) (3 qian) Guixu (Radix Angelicae Sinensis Tail) (3 qian) Yujin (Radix Curcumae Longae) (2 qian) Qingpi (Pericarpium Citri Reticulatae Viride) (2 qian) Houpo (Cortex Magnoliae Officinalis) (3 qian) Dafupi (Pericarpium Arecae) (3 qian) Yunling (Poria) (6 qian) Banxia (Rhizoma Pinelliae Ternatae) (4 qian).
Boil to three cups, divide into three doses. If unable to relax and dispel anger, medication is unnecessary.
26th Day: After eight doses of the previous formula, swelling slightly receded. Yang pulses were weak, added Jiaotan 3 qian. Constipation, added Liang Toujian (Rhizoma Belamcandae Chinensis) 3 qian to remove old stasis.