族嫂汪氏，发寒发热，头疼遍身痛，眼珠疼，小腹痛，里急后重，赤白脓血日夜三十余
度
，口渴，此疟痢并作也。以柴胡、葛根、甘草、青蒿、枳壳、酒芩、酒连、当归、白芍、桂
枝、防风、羌活、川芎水煎服之，外与神授香连丸。其夜痢减十之九，但遍身尚疼，略恶
寒，
不发热，头略晕而已，改以川芎、川归、白芍、木香、桂皮、陈皮、酒连、酒芩，调理三日
全安。
仲 侄孙，赴府考试，过食牛面且劳苦，因而发疟。城中医疟半月，形神俱瘦，疟愈而
腹大
如箕矣。健所黄夫人，仲暗岳母也。凡名家递为延至，率认疟后腹胀，其中必有疟母为祟也
。诸消痞药尝之不效，又以五皮饮利之不应，将议攻下，而予适至。观其色黄口渴，小水短
涩，腹胀不可言，足膝之下肿大不能行，两腿肿连阴囊，气壅不能卧，饮食绝少，脉才四至
，大而不敛。予曰∶此真气虚中满症也，法当温补下元而兼理脾，病犹可愈。若攻下是杀之
也。渠父与予浓，今宦河南，予安得不为渠任其重哉!顾歙友所用之剂，乃皂荚、槟榔、三
棱、莪术、姜黄、葶苈子、木通、枳实、陈皮、
浓朴、山栀、大黄、牵牛、黄连等皆破敌有余之品，见之且骇然，但黄夫人荐来之医又不能
拒，正踌躇间，幸渠乃伯溪亭公知予心，卒谢歙医而一任予治。予即以人参、白术各三钱，
炙甘草五分，大附子、炮干姜、桂心各一钱，破故纸二钱、桑白皮、砂仁、茯苓、泽泻各八
分，水煎饮之。其夜小水稍利，喘急稍缓，连饮五日，腹稍宽，皮作皱。因食猪肚子大早，
依旧作胀，前方人参、白术加至五钱，再加陈皮八分，又二十剂而腹消其大半，乃能伏枕而
卧，始能移步行动。改以参苓白术散加破故纸、肉桂调养而安。溪亭公问曰∶腹胀如此，口
渴如此，小水短涩如此，诸人悉认为热、为有余，乃今以温补收功何也？予曰∶公不观古人
以气虚中满名鼓胀耶？由气虚所以成中满，设气不虚，何中满之有哉？且鼓者，外皮坚紧而内
空无物，若复泻之，真元脱矣，安能复生？故惟有补而已。口渴、小水少者，皆元气虚弱不
能运转。清气不上升故口渴；浊气不下降，故无小便。乃天地不交之否。兹特补其下元，俾
水火充实，阳气上腾，浊气下降，中气运动，而诸疾皆瘳也。
族嫂汪氏，出现怕冷发热、头痛及全身疼痛、眼球疼痛、小腹痛、里急后重（想排便但排不出或排不尽感）、排泄赤白脓血且日夜达三十多次、口渴，这是疟疾与痢疾同时发作。用柴胡、葛根、甘草、青蒿、枳壳、酒炒黄芩、酒炒黄连、当归、白芍、桂枝、防风、羌活、川芎水煎服用，外用神授香连丸。当晚痢疾减轻了十分之九，只是全身仍然疼痛，略微怕冷，不再发热，头部略微眩晕而已，改为用川芎、川当归、白芍、木香、桂皮、陈皮、酒黄连、酒黄芩，调理三天后完全康复。
仲侄孙，去府城参加科举考试，因饮食过量食用牛肉面条且劳累辛苦，因而引发疟疾。城中医生治疗疟疾半个月，导致他形体和精神都消瘦，疟疾好了但腹部像簸箕一样大。健所黄夫人，是仲的暗岳母。凡是名医都被陆续请来，都认为是疟疾后的腹胀，其中必有“疟母”（疟疾日久形成的痞块）在作祟。各种消痞药尝试过都不见效，又用五皮饮利水消肿也不应验，准备讨论使用攻下法，而我恰好到了。观察他的面色发黄、口渴、小便短少涩滞，腹胀严重得无法形容，足膝以下肿大不能行走，双腿肿胀牵连阴囊，气机壅滞不能平卧，饮食极少，脉象仅四至（每分钟跳动次数），脉形大而散漫不收敛。我说：这是真气虚弱导致的“中满”症，治法应当温补下元并兼理脾胃，病还可以痊愈。如果攻下就是杀了他。他的父亲与我关系深厚，如今在河南做官，我怎能不为他承担重任呢！但是歙县朋友所用的方剂，乃是皂荚、槟榔、三棱、莪术、姜黄、葶苈子、木通、枳实、陈皮、厚朴、山栀、大黄、牵牛、黄连等，都是攻破敌邪有余的药物，看到这些我都感到惊骇，但黄夫人推荐的医生又不能拒绝，正犹豫间，幸好他的伯父溪亭公了解我的心意，最终辞退了歙县的医生，完全交给我治疗。我立即用人参、白术各三钱，炙甘草五分，大附子、炮干姜、桂心各一钱，破故纸二钱、桑白皮、砂仁、茯苓、泽泻各八分，水煎服用。当晚小便稍微通畅，喘急稍微缓解，连续饮用五天，腹部稍微宽松，皮肤起皱。因为吃了猪肚子和大枣，再次胀满，前方的人参、白术加到五钱，再加陈皮八分，又服二十剂后腹部消减了大半，才能伏枕而卧，开始能移步行动。改为用参苓白术散加破故纸、肉桂调养而安定。溪亭公问我说：腹胀如此严重，口渴如此厉害，小便短少涩滞如此，众人都认为是热证、实证，如今却以温补收效，为什么呢？我说：您没看过古人将气虚中满称为鼓胀吗？正因为气虚所以形成中满，假如气不虚，哪里会有中满呢？况且鼓胀，外皮坚紧而内部空无物，如果再泻它，真元就会脱失，怎么能再生呢？所以只有补这一条路。口渴、小便少的，都是元气虚弱不能运转所致。清气不上升所以口渴；浊气不下降，所以没有小便。这是天地之气不交的“否”卦之象。现在特别补益下元，使水火充实，阳气上腾，浊气下降，中气运动，那么各种疾病都会痊愈。
Zu Sao (Clan sister-in-law) Wang Shi experienced chills and fever, headache, generalized body pain, eyeball pain, lower abdominal pain, tenesmus (urgency with little passage), passing of red and white purulent blood more than thirty times a day, and thirst. This was malaria and dysentery occurring simultaneously. She was prescribed Chai Hu (Bupleuri Radix), Ge Gen (Puerariae Lobatae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Qing Hao (Artemisiae Annuae Herba), Zhi Ke (Aurantii Fructus), Jiu Huang Qin (Scutellariae Radix prepared with wine), Jiu Lian Lian (Coptidis Rhizoma prepared with wine), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Gui Zhi (Cinnamomi Ramulus), Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), and Chuan Xiong (Ligustici Chuanxiong Rhizoma) decocted in water for oral administration, along with Shen Shou Xiang Lian Wan (Divine Bestowal Fragrant Coptis Pill) applied externally. That night, the dysentery decreased by nine-tenths, but generalized body pain persisted, with slight aversion to cold, no fever, and only slight dizziness. The prescription was changed to Chuan Xiong, Chuan Dang Gui (Angelicae Sinensis Radix from Sichuan), Bai Shao, Mu Xiang (Aucklandiae Radix), Gui Pi (Cinnamomi Cortex), Chen Pi (Citri Reticulatae Pericarpium), Jiu Lian Lian, and Jiu Huang Qin, which regulated her condition for three days until she fully recovered.
Zhong's nephew grandson went to the prefectural city for the imperial examination. Due to overeating beef noodles and hard labor, he developed malaria. Physicians in the city treated him for half a month, causing his form and spirit to become emaciated. Although the malaria subsided, his abdomen became distended like a winnowing basket. Huang Furen (Lady Huang) of Jiansuo was Zhong's secret mother-in-law. Famous physicians were successively invited, all attributing the post-malaria abdominal distension to the presence of "Mamo" (malaria mass). Various medicines for dissipating masses proved ineffective. Then, Wupi Yin (Five-Bark Decoction) was used to promote diuresis without effect. An attack-based purgative method was being considered when I arrived. Observing his sallow complexion, thirst, scanty and difficult urination, unbearable abdominal distension, swelling below the knees preventing walking, leg swelling extending to the scrotum, qi stagnation preventing lying flat, minimal food intake, and a pulse rate of only four beats per cycle, large but not firm, I said: This is a syndrome of middle-fullness due to true qi deficiency. The treatment should warm and tonify the lower origin while regulating the spleen; the disease can still be cured. Purgation would be fatal. His father had a deep bond with me, and as he now holds office in Henan, how could I not take responsibility? However, the formula used by friends from Xi County contained Zao Jia (Gleditsiae Sinensis Fructus), Bing Lang (Arecae Semen), San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Jiang Huang (Curcumae Longae Rhizoma), Ting Li Zi (Lepidii Semen), Mu Tong (Akebiae Caulis), Zhi Shi (Aurantii Fructus Immaturus), Chen Pi, Hou Po (Magnoliae Officinalis Cortex), Shan Zhi (Gardeniae Fructus), Da Huang (Rhei Radix et Rhizoma), Qian Niu (Pharbitidis Semen), and Huang Lian (Coptidis Rhizoma)—all substances powerful enough to break down pathogens. Seeing these shocked me. Since I could not refuse the physician recommended by Lady Huang, I was hesitating when fortunately, his uncle, Mr. Xiting, understood my intentions. They dismissed the Xi doctor and entrusted the case entirely to me. I immediately prescribed Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) each 3 qian, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 5 fen, Da Fu Zi (Aconiti Lateralis Radix Praeparata), Pao Gan Jiang (Zingiberis Rhizoma Praeparatum), and Gui Xin (Cinnamomi Ramulus medullary part) each 1 qian, Po Gu Zhi (Psoraleae Fructus) 2 qian, Sang Bai Pi (Mori Cortex), Sha Ren (Amomi Fructus Rotundus), Fu Ling (Poria), and Ze Xie (Alismatis Rhizoma) each 8 fen, decocted in water for drinking. That night, urination improved slightly, and panting eased. After five days of continuous administration, the abdomen relaxed somewhat, and the skin wrinkled. However, after eating pig stomach and large dates, the distension returned. The previous formula's Ren Shen and Bai Zhu were increased to 5 qian each, plus Chen Pi 8 fen. After another twenty doses, the abdominal distension reduced by more than half, allowing him to lie on his pillow and walk again. The prescription was changed to Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) added with Po Gu Zhi and Rou Gui (Cinnamomi Cortex) for convalescence, leading to stability. Mr. Xiting asked: With such severe abdominal distension, such intense thirst, and such scanty, difficult urination, everyone considered it heat and excess. Why did you achieve success with warming and tonifying? I replied: Have you not seen that ancients named this middle-fullness due to qi deficiency as "Gu Zhang" (Drum Distension)? It is precisely because of qi deficiency that middle-fullness forms; if qi were not deficient, where would middle-fullness come from? Moreover, in drum distension, the outer skin is tight and hard while the inside is empty. If purged further, the true yuan (original essence) will collapse, and life cannot be restored. Therefore, only tonification is possible. Thirst and scanty urine are both caused by weak yuan qi failing to circulate. Clear qi fails to ascend, causing thirst; turbid qi fails to descend, causing absence of urine. This is the state of "Pi" (Stagnation/Obstruction) where heaven and earth do not interact. By specifically tonifying the lower origin, we enrich water and fire, allow yang qi to ascend, turbid qi to descend, and middle qi to move, thereby curing all diseases.