汪希明,竹山丈长君也。年弱冠,性多躁,素有痰火,旧曾吐红。张医用收涩之剂太早
,以
致痰与瘀血留滞经络,酿成病根,恬不知觉,且为灸肺俞、膏肓,撼动前疾。止涩无功,
滋阴作壅,咳不能睡。又误作风邪而投发散风剂,不思火盛得风,其势愈炽,血从口鼻喷出
,势如泉涌。延予为治,六部洪数,身热而烦,又时当三伏,内外之火夹攻,纵体质刚劲,
宁能堪此销铄哉。予思非釜底抽薪之法难夺其上涌之势,乃以三制大黄三钱,石膏五钱,黄
连、茜根、滑石各二钱,牡丹皮一钱,急煎饮之,大便微行二次,血来少缓。即用石膏、滑
石、冬青子各三钱、旱莲草、茜根各二钱,黄连、山栀、贝母各一钱,甘草五分,茅草根五
钱煎服,血乃全止。三日后大便结燥,火又上逆,咳咳连声,左关脉弦劲,右关洪滑,与当
归龙荟丸下之,而咳始缓。改以栝蒌仁、茜根各一钱五分,贝母、旱莲草、麦门冬、知母各
一钱,白芍药二钱,黄连、黄芩各七分,青皮、甘草各三分,仍加茅根。后每遇大便燥结即
进龙荟丸,迹此调理三月大定,半载全瘳。书云∶病有六不炙,火盛者不炙。此由误炙,几
于不保,故特识之以为好炙者龟鉴。
德兴文学祝弘吾公,祝令君叔祖也。在休衙,偶有阴阳之患,子午潮热,咳嗽痰多,汗
流不
止,胸膈不畅,大便燥结,动作喘乏口渴。以贝母、知母、栝蒌仁、桑白皮各一钱,枳壳、
黄连、麦门冬各八分,桔梗、柴胡、前胡各五分,甘草三分,五味子十一粒服下,五更微汗
,热退十之七,惟痰嗽喘乏,改用栝蒌仁二钱,余如前,外以七制化痰丸夜服热尽退。渠甚
喜,以为自是以往,可勿药矣。予曰∶未也,据脉弦数不减,恐防作疟,公未为然。予适东
行半月,书报疟作,咳嗽转加,所出皆黄粘老痰。予曰∶书云无痰不作疟。仍用前方倍加柴
胡、贝母为君,加乌梅一个,四剂霍然良已。公曰∶翁之视疾,应若桴鼓。古云∶智者不治
已病治未病。吾于翁言征之,乃以是备言祝令公。祝令公喜曰∶孙君匪独得岐黄正脉,其雅
谊足称,叔祖尚未前闻,予当赋诗以赠。于是欣然手书若干律以授予,其诗附后第六卷。
汪希明,是竹山的一位德高望重的长者。他刚成年时,性格急躁,体内素有痰火,曾经有过咳血(吐红)的症状。之前的医生过早使用了收敛固涩的药物,导致痰浊与瘀血滞留于经络之中,酿成了疾病的根源,患者自己却毫无察觉。此外,医生还为他施灸肺俞穴和膏肓穴,扰动并加重了旧疾。此时,单纯止涩无效,滋阴药物又因滋腻而阻碍气机,导致咳嗽严重到无法入睡。后来又被误认为是外感风邪,投以发散风邪的药剂。未曾想到,火势旺盛之时再受风药升散之助,病情更加炽烈,血液从口鼻喷出,势如泉涌。
于是延请我诊治。诊见六部脉象均洪大而数,身体发热且烦躁不安,加之正值三伏天,内外之火相互夹攻,纵然体质强健,怎能承受这种消耗呢?我思考后认为,非用“釜底抽薪”之法难以遏制其向上涌溢的血势。于是使用经过三次炮制的大黄三钱、石膏五钱、黄连、茜草根、滑石各二钱、牡丹皮一钱,急火煎煮后让患者服用。服药后大便微通两次,出血势头稍缓。随即改用石膏、滑石、冬青子各三钱、旱莲草、茜草根各二钱、黄连、山栀、贝母各一钱、甘草五分、茅草根五钱煎服,出血完全停止。
三天后,大便变得干结,火气再次上逆,连续咳嗽不止,左关脉弦劲有力,右关脉洪滑。给予当归龙荟丸泻下通便,咳嗽才开始缓解。随后改为栝蒌仁、茜草根各一钱五分、贝母、旱莲草、麦门冬、知母各一钱、白芍药二钱、黄连、黄芩各七分、青皮、甘草各三分,仍然加入茅根。此后每逢大便干燥结滞即服用龙荟丸,依此方法调理三个月后病情基本稳定,半年后完全康复。医书说:“疾病有六种情况不宜艾灸,火盛者不可艾灸。”这次是因为误用艾灸,几乎导致死亡,所以特别记录下来,作为喜欢艾灸者的借鉴。
德兴的文人祝弘吾先生,是祝县令的叔祖。他在休职居家期间,偶尔出现阴阳失调的病症,表现为午时和子时潮热,咳嗽痰多,汗流不止,胸膈部不畅快,大便干燥结滞,活动时气喘乏力、口渴。我开具贝母、知母、栝蒌仁、桑白皮各一钱,枳壳、黄连、麦门冬各八分,桔梗、柴胡、前胡各五分,甘草三分,五味子十一粒,让患者服用。五更时分微微出汗,热度退了十分之七,只剩下痰嗽和气喘乏力。于是改用栝蒌仁二钱,其余药物剂量不变,夜间加服七制化痰丸,直到热气完全退去。患者非常高兴,认为从此以后可以不用吃药了。我说:“还不行,根据脉象弦数未减,恐怕会发作疟疾。”先生并不以为然。恰逢我要向东出行半个月,书信回报说疟疾发作,咳嗽也加重了,所咳出的都是黄色粘稠的老痰。我说:“医书说无痰不作疟。”仍然使用前方,加倍柴胡、贝母作为主药,加乌梅一个,服用四剂后病愈。先生说:“您看病,反应像鼓槌击鼓一样迅速准确。古话说:‘智者不治疗已发生的疾病,而是预防未发生的疾病。’我从您的话中验证了这一点。”于是将这些详细告诉了祝县令。祝县令高兴地说:“孙君不仅深得岐黄医学的正统脉络,其高雅的情谊也值得称赞。我叔祖之前未曾听闻,我应当赋诗赠送。”于是欣然手写若干律诗交给我,诗作附在第六卷之后。
Wang Ximing was a respected elder in Zhushan. In his early adulthood, he had an irritable temperament and suffered from phlegm-fire (Tan Huo) internally, with a history of hemoptysis (Tu Hong). A previous physician used astringent agents too early, causing phlegm and blood stasis (Yu Xue) to stagnate in the meridians, forming the root of the disease. The patient remained unaware of this, and furthermore, moxibustion was applied to Feishu (BL13) and Gaohuang (BL43), aggravating the pre-existing condition. Simple astringency proved ineffective, and yin-nourishing herbs caused obstruction due to their cloying nature, resulting in coughing so severe that sleep was impossible. He was then mistakenly diagnosed with wind-pathogen invasion and treated with diaphoretic formulas. Unaware that fire-heat intensified by wind-dispersing herbs would flare up further, the patient experienced spurting hemoptysis from the mouth and nose, resembling a gushing spring.
I was then consulted. The pulse was surging and rapid in all six positions. The body was hot and restless. Given that it was the height of summer (Sanfu days), internal and external fire were attacking simultaneously. Even with a robust constitution, how could one withstand such consumption? I reasoned that only a method akin to "drawing firewood from under the cauldron" (Fu Di Chou Xin) could curb the upward surging of blood. Therefore, I prescribed three-times processed Rhizoma Rhei Preparata (Sanzhi Dahuang) 3 qian, Gypsum Fibrosum (Shigao) 5 qian, Radix Coptidis (Huanglian), Radix Rubiae (Qiangen), and Talcum (Huashi) each 2 qian, and Cortex Moutan (Mudanpi) 1 qian. This was decocted rapidly and administered. After two slight bowel movements, the bleeding slowed. Immediately thereafter, I prescribed Gypsum Fibrosum (Shigao), Talcum (Huashi), and Fructus Ligustri Lucidi (Dongqingzi) each 3 qian, Herba Ecliptae (Hanliancao) and Radix Rubiae (Qiangen) each 2 qian, Radix Coptidis (Huanglian), Fructus Gardeniae (Shanzhi), and Radix Bletillae (Beimu) each 1 qian, Radix Glycyrrhizae (Gancao) 0.5 fen, and Radix Imperatae (Maogen) 5 qian. Decocted and taken, the bleeding stopped completely.
Three days later, the stool became dry and hard, and the fire rose again, causing continuous coughing. The left guan pulse was wiry and forceful, while the right guan pulse was surging and slippery. I administered Danggui Longhui Wan (Angelica Sinensis and Gardenia Pill) to purge the bowels, after which the cough began to subside. The prescription was then changed to Pericarpium Trichosanthis (Gualouren) and Radix Rubiae (Qiangen) each 1.5 qian, Radix Bletillae (Beimu), Herba Ecliptae (Hanliancao), Radix Ophiopogonis (Maimendong), and Radix Anemarrhenae (Zhimu) each 1 qian, Radix Paeoniae Alba (Baishao) 2 qian, Radix Coptidis (Huanglian) and Radix Scutellariae (Huangqin) each 0.7 fen, Fructus Aurantii (Qingpi) and Radix Glycyrrhizae (Gancao) each 0.3 fen, still adding Radix Imperatae (Maogen). Thereafter, whenever constipation occurred, Longhui Wan was administered. Following this regimen for three months, the condition stabilized; after half a year, full recovery was achieved. Medical texts state: "There are six conditions where moxibustion is contraindicated; those with excess fire must not be moxed." This case resulted from erroneous moxibustion, nearly leading to death, so I recorded it specifically as a warning for those fond of moxibustion.
Zhu Hongwu, a scholar from Dexing and the great-uncle of Magistrate Zhu, was retired at home. He occasionally suffered from yin-yang imbalance, presenting with tidal fever at wu and zi hours, cough with profuse sputum, incessant sweating, chest and diaphragm discomfort, dry and hard stools, and panting, fatigue, and thirst upon exertion. I prescribed Radix Bletillae (Beimu), Radix Anemarrhenae (Zhimu), Pericarpium Trichosanthis (Gualouren), and Cortex Moriperiphyllae (Sangbaipi) each 1 qian, Fructus Aurantii (Zhike), Radix Coptidis (Huanglian), and Radix Ophiopogonis (Maimendong) each 0.8 fen, Radix Platycodi (Jiegeng), Radix Bupleuri (Chaihu), and Radix Peucedani (Qianhu) each 0.5 fen, Radix Glycyrrhizae (Gancao) 0.3 fen, and Semen Schisandrae (Wuweizi) 11 grains. Taken orally, slight sweating occurred at dawn, reducing the fever by seventy percent. Only sputum-cough, panting, and fatigue remained. Thus, I changed the formula to Pericarpium Trichosanthis (Gualouren) 2 qian, keeping other dosages as before, and added Qizhi Huatan Wan (Seven-Processed Phlegm-Resolving Pill) at night until the heat completely subsided. The patient was very pleased, believing he could cease medication henceforth. I said, "Not yet. According to the wiry and rapid pulse, malaria may develop." He did not agree. As I traveled east for half a month, a letter reported the onset of malaria, with worsened coughing and expectoration of thick, yellow, old phlegm. I stated, "Medical texts say: 'No phlegm, no malaria.'" I retained the previous formula, doubling Chaihu and Beimu as the chief herbs, adding one Fructus Mume (Wumei), and after four doses, he recovered miraculously. The patient remarked, "Your diagnosis is as responsive as a drumstick striking a drum. The ancients said: 'The wise do not treat existing diseases but prevent impending ones.' I have verified this through your words." He then recounted this to Magistrate Zhu. Magistrate Zhu joyfully said, "Dr. Sun not only possesses the orthodox lineage of Qi and Huang but also displays elegant friendship. My great-uncle had not previously heard of him. I shall compose a poem to present to him." Thus, he happily wrote several regulated verses and gave them to me, which are attached in Volume Six.