沈晴岳先生，五更耳鸣，腹不舒畅，稍劳则烘然热，自汗。脉右关滑大有力，左脉和缓
。原
为当风睡卧而得，素来上焦有痰火，午后过劳或受饿，大作眩晕，冷汗津津，再不敢动，稍
动则呕吐，此皆痰火所致，盖无痰不作晕也。先与藿香正气散一帖，以去表里之邪；继与温
胆汤加天麻，服后眩晕、呕吐皆止。次日诊之，右关脉仍滑，此中焦食积痰饮胶固已久，卒
难动摇，姑以二陈汤加枳实、黄连、滑石、天花粉、天麻、竹茹调理，后以当归龙荟丸
加牛胆南星、青礞石，凡数帖痊愈。
潘景宇内人，后半夜不睡，面黄肌瘦，两太阳及眉棱骨痛，大便溏，稍劳动则体热，四
肢无
力。其脉左寸洪滑，自春至秋皆然。此由脾虚，肝心二经火盛然也。先用四君子加酒连、柴
胡、
白扁豆、泽泻、滑石调理，夜与钱仲阳安神丸数粒，灯心汤送下。服八日得睡，两太阳亦不
痛，继用六君子加黄 、秦艽、柴胡、
泽泻、当归、白芍药、黄柏，全安。
臧六老，上吐血下泻血，胸膈背心皆胀，原从怒触，又犬肉所伤，故发热而渴。医者皆
作阴
虚火动，而为滋阴降火，胸背愈胀，血来更多。予诊之，两关俱洪滑有力。谓曰∶此肝脾二
经有余症也，作阴虚治，左矣!《内经》曰∶怒伤肝。甚则呕血并下泄。胸背胀痛，瘀血使
然。脾为犬肉所伤，故不能统血。今误用地黄、麦冬、黄柏、知母等剂，是以脾益伤，而上
焦瘀血愈滞也。惟调气健脾兼之消导，则万全矣。六老曰∶人皆谓劳怯，故发热吐红，血上
吐，阳络伤也；血下行，阴络伤也。阴阳俱伤，法当不治，公独认非阴虚何也？予曰∶脉书
云∶脉数无力者阴虚也。今脉固非阴虚。书又曰∶凡阴虚之热，发于申酉戌间，夜半而退，
明日犹是，如潮信然。以下午乃阴分主事，故曰阴虚潮热也。今热不分昼夜，而症亦非阴虚
，故曰作阴虚治者左也。六老闻言大喜曰∶公诚见垣一方者，幸惠一匕以生之。即与山楂、
香附、枳实，调气消导为君；丹参、丹皮、桃仁、滑石、茅根化瘀血为臣；黄连、芦根，解
犬
肉之热为佐。四帖，胸背宽，血吐止，惟腹中不舒，仍以前药同丹溪保和丸与之，四帖，大
便下极臭黑粪半桶，寝食俱安矣。
沈晴岳先生，每至五更时分出现耳鸣，腹部感觉不舒畅，稍微劳累就会感到身体烘热，并伴有自汗。诊察发现右关脉滑大有力，左脉和缓。此病起因是睡觉时对着风，素来上焦有痰火，午后过度劳累或饥饿时，会引发严重的眩晕，出冷汗，不敢动弹，稍一活动就会呕吐，这些都是痰火所致，因为无痰就不会发生眩晕。先给予藿香正气散一剂，以祛除表里之邪；随后给予温胆汤加天麻，服用后眩晕、呕吐都停止了。第二天诊察，右关脉仍然滑，这说明中焦食积和痰饮胶结已久，难以迅速动摇，暂且用二陈汤加枳实、黄连、滑石、天花粉、天麻、竹茹进行调理，后来用当归龙荟丸加牛胆南星、青礞石，经过数剂药后痊愈。
潘景宇的夫人，后半夜睡不着觉，面色发黄，肌肉消瘦，两侧太阳穴及眉棱骨疼痛，大便稀溏，稍微劳动就身体发热，四肢无力。其脉象左寸洪滑，从春季到秋季都是如此。这是由于脾虚，肝、心两经火盛所致。先用四君子汤加酒炒黄连、柴胡、白扁豆、泽泻、滑石进行调理，晚上服用钱仲阳安神丸几粒，用灯心草汤送服。服药八天后能入睡，两侧太阳穴也不痛了，接着用六君子汤加黄芩、秦艽、柴胡、泽泻、当归、白芍药、黄柏，完全康复。
臧六老，上部吐血，下部便血，胸膈和背部都胀满，起因是愤怒触动肝气，又因食用狗肉受伤，所以发热且口渴。医生们都认为是阴虚火动，采用滋阴降火的方法治疗，导致胸背更加胀满，出血更多。我诊察他，两关脉都洪滑有力。我对他说：这是肝脾两经有余的症状，按阴虚治疗是错误的！《内经》说：怒伤肝。严重时会出现呕血并伴随下泄。胸背胀痛，是瘀血造成的。脾脏被狗肉所伤，所以不能统摄血液。现在误用地黄、麦冬、黄柏、知母等药物，使得脾脏更加受损，而上焦的瘀血更加停滞。只有调气健脾兼以消导，才能万全。臧六老说：人们都说这是劳怯（虚劳），所以发热吐红，血从上吐出来，是阳络受伤；血向下走，是阴络受伤。阴阳都受伤，按照法则应当是不治之症，您为什么唯独认为不是阴虚呢？我说：脉书说：脉数而无力的是阴虚。现在的脉象确实不是阴虚。脉书又说：凡是阴虚的热，发于申、酉、戌三个时辰之间，半夜退去，第二天依然如此，像潮水一样准时。因为下午是阴分主事的时候，所以叫阴虚潮热。现在发热不分昼夜，而且症状也不是阴虚，所以说按阴虚治疗是错误的。臧六老听了非常高兴说：您确实是见识高明的医生，希望赐我一剂药救活我。随即给予山楂、香附、枳实，以调气消导为主药；丹参、丹皮、桃仁、滑石、茅根，以化瘀血为辅药；黄连、芦根，以解除狗肉之热为佐药。服用四帖后，胸背宽舒，吐血停止，只是腹中不舒服，仍然用前面的药同丹溪保和丸一起给他服用，再服四帖，大便排出极臭的黑粪半桶，睡眠和饮食都安适了。
Mr. Shen Qingyue experienced tinnitus every time at the fifth watch (early morning), discomfort in the abdomen, and a sensation of body heat with spontaneous sweating upon slight exertion. The pulse at the right Guan position was slippery, large, and forceful, while the left pulse was harmonious and slow. This condition originated from sleeping exposed to wind; he had phlegm-fire in the upper Jiao (Upper Burner) normally. Severe vertigo, cold sweats profusely, immobility, and vomiting upon slight movement occurred after overexertion or hunger in the afternoon. All these were caused by phlegm-fire, for "without phlegm, there is no vertigo." Initially, Huoxiang Zhengqi San (Patchouli Powder to Rectify the Qi) was given for one dose to dispel pathogenic factors in both the exterior and interior; subsequently, Wendan Tang (Warm the Gallbladder Decoction) with Tianma (Gastrodiae Rhizoma) was administered, after which vertigo and vomiting ceased. On the next day, the right Guan pulse remained slippery, indicating that food stagnation and phlegm-fluids in the Middle Jiao (Middle Burner) had been firmly consolidated for a long time and were difficult to dislodge immediately. Therefore, Erchen Tang (Two-Cured Decoction) with Zhishi (Aurantii Fructus), Huanglian (Coptidis Rhizoma), Huashi (Talcum), Tianhua Fen (Trichosanthis Radix), Tianma (Gastrodiae Rhizoma), and Zhuru (Bambusae Caulis in Taenia) was used for regulation. Later, Danggui Longhui Wan (Angelica Sinensis and Gardenia Pill) with Niudan Xing (Arisaema cum Bile) and Qingmengshi (Calcareous Schist) was prescribed. After several doses, he recovered completely.
Mrs. Pan Jingyu could not sleep during the latter half of the night. Her complexion was sallow, her muscles emaciated, and she suffered pain in both temples and the supraorbital ridge. Her stools were loose, and she felt hot and weak in the limbs upon slight exertion. Her pulse at the left Cun position was surging and slippery, a pattern persisting from spring to autumn. This was due to Spleen deficiency and excessive fire in the Liver and Heart meridians. Initially, Sijunzi Tang (Four Gentlemen Decoction) with Jiuhuanglian (Coptidis Rhizoma fried with wine), Chaihu (Bupleuri Radix), Baibian Dou (Dolichos Lablab Semen), Zexie (Alismatis Rhizoma), and Huashi (Talcum) was used for regulation. At night, Anshen Wan (Spirit-Calming Pill) by Qian Zhongyang was given in small quantities, taken down with Dengxin Tang (Junci Medulla Decoction). After eight days of medication, she could sleep, and the temple pain subsided. Subsequently, Liujunzi Tang (Six Gentlemen Decoction) with Huangqin (Scutellariae Radix), Qinjiao (Gentianae Macrophyllae Radix), Chaihu (Bupleuri Radix), Zexie (Alismatis Rhizoma), Danggui (Angelicae Sinensis Radix), Baishao Yao (Paeoniae Radix Alba), and Huangbai (Phellodendri Cortex) was administered, leading to complete recovery.
Elder Zang Liu suffered from hematemesis (vomiting blood) above and hematochezia (bleeding from the anus) below, with distension in the chest, diaphragm, and back. The origin was anger injuring the Liver, compounded by injury from eating dog meat, resulting in fever and thirst. Physicians all diagnosed it as Yin deficiency with fire hyperactivity and treated it with nourishing Yin and descending fire. Consequently, the chest and back distension worsened, and bleeding increased. Upon examination, I found both Guan pulses to be surging, slippery, and forceful. I told him: "This is an excess syndrome of the Liver and Spleen meridians. Treating it as Yin deficiency is incorrect!" The *Neijing* states: "Anger injures the Liver. In severe cases, it leads to vomiting blood and lower discharge." The distension and pain in the chest and back are caused by blood stasis. The Spleen was injured by the dog meat, thus failing to control the blood. The erroneous use of herbs such as Dihuang (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Huangbai (Phellodendri Cortex), and Zimu (Anemarrhenae Rhizoma) has further damaged the Spleen and caused upper Jiao blood stasis to stagnate more severely. Only by regulating Qi, strengthening the Spleen, and promoting digestion can the outcome be perfect. Elder Zang said: "People say this is consumptive disease (Lao Que), hence fever and hematemesis. Blood vomiting upwards indicates injury to the Yang collaterals; blood flowing downwards indicates injury to the Yin collaterals. With both Yin and Yang injured, it should be incurable according to the rules. Why do you insist it is not Yin deficiency?" I replied: "The pulse classics state: 'A rapid but forceless pulse indicates Yin deficiency.' Your current pulse is certainly not indicative of Yin deficiency. The classics also state: 'Heat from Yin deficiency typically arises between the Shen, You, and Xu hours (3 PM - 9 PM), subsides at midnight, and recurs the next day, like the tide.' Since the afternoon is governed by Yin, it is called tidal fever of Yin deficiency. Your fever occurs regardless of day or night, and your symptoms do not match Yin deficiency. Therefore, treating it as Yin deficiency is wrong." Elder Zang was greatly delighted and said: "You are indeed a physician of exceptional insight. Please grant me a dose to save my life." I immediately prescribed Shanzha (Crataegi Fructus), Xiangfu (Cyperi Rhizoma), and Zhishi (Aurantii Fructus) as the sovereign herbs to regulate Qi and promote digestion; Danshen (Salviae Miltiorrhizae Radix), Danpi (Moutan Cortex), Taoren (Persicae Semen), Huashi (Talcum), and Maogen (Imperatae Rhizoma) as the minister herbs to resolve blood stasis; Huanglian (Coptidis Rhizoma) and Lugen (Phragmitis Rhizoma) as the assistant herbs to clear the heat from dog meat. After four doses, the chest and back felt relaxed, and hematemesis stopped. However, abdominal discomfort persisted. The previous prescription was combined with Baohe Wan (Preserve Harmony Pill) by Zhu Danxi and administered. After another four doses, half a bucket of extremely foul-smelling black stool was passed, and sleep and appetite returned to normal.